Endovascular treatment of blunt traumatic injuries of the subclavian and axillary arteries

• Autor(a) principal: Oliveira,Nelson
• Data de Publicação: 2014
• Outros Autores: Alves,Gonçalo, Rodrigues,Hugo, Gonçalves,Frederico Bastos, Martins,João, Morais,José Aragão, Ferreira,Maria Emília, Castro,João Albuquerque, Capitão,Luís Mota
• Tipo de documento: Relatório
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2014000300006
• topic: Blunt trauma; Endovascular treatment; Axillary artery; Subclavian artery; Stent

Introduction: Blunt trauma of the axillary and subclavian arteries is uncommon. Conventional surgery presents significant morbidity associated to the need of extensive exposure and challenging dissection through traumatized tissues. Endovascular treatment is an alternative that has increasingly been used in traumatic arterial injuries. This report presents three cases that were managed by endovascular techniques. Methods: We report the cases of three patients with blunt traumatic injuries of the subclavian and axillary arteries who were treated at our Institution in 2013 with endovascular techniques. Each case presented distinctly, resulting from different traumatic mechanisms and the therapeutical approach was adapted accordingly. Results: Case 1: A 68-year-old man was admitted with an acute limb ischemia of the left upper limb after a fall from his own walking height. A computerized tomography angiography demonstrated a dissection of the left subclavian artery. Resource to a proximal angioplasty with stent allowed the recovery of the limb perfusion fixating the flap. Case 2: A 34-year-old male who fell from a height of 8 m, with multiple costal arch fractures and the complete transection of the subclavian artery. In this case, a covered stent excluded the rupture. Case 3: A 45-year-old woman presented to our department with an acutely ischemic left upper limb with 3 days of progression after a distension of the scapuloh-umeral articulation. Although a digital amputation was ultimately necessary, hand-salvage was accomplished through thrombectomy and catheter-directed thrombolysis. Conclusion: Blunt trauma of the axillosubclavian arteries is rare and its diagnosis may be challenging. Endovascular treatment of blunt traumatic injuries of the subclavian and axillary arteries is an alternative to traditional surgical treatment, which may be used solely or in combination with the latter to reduce invasiveness and improve outcome of arterial injuries. © 2014 Sociedade Portuguesa de Angiologia e Cirurgia Vascular. Published by Elsevier España, S.L.U. All rights reserved.