J Korean Soc Traumatol.  2013 Sep;26(3):243-247.

Treatment of Subclavian Artery Injury in Multiple Trauma Patients by Using an Endovascular Approach: Two Cases

• Cho J
• Jung H
• Kim HK
• Lim KH
• Park J
• Huh S

Abstract

INTRODUCTION
Surgical treatment of subclavian artery (SA) injury is challenging because approaching the lesion directly and clamping the proximal artery is difficult. This can be overcome by using an endovascular technique. CASE 1: A 37-year-old male was drawn into the concrete mixer truck. He had a right SA injury with multiple traumatic injuries: an open fracture of the right leg with posterior tibial artery (PTA) injury, a right hemothorax, and fractures of the clavicle, scapula, ribs, cervical spine and nasal bone. The injury severity score (ISS) was 27. Computed tomography (CT) showed a 30-mm-length thrombotic occlusion in the right SA, which was 15 mm distal to the vertebral artery (VA). A self-expandable stent(8 mmx40 mm in size) was deployed through the right femoral artery while preserving VA flow, and the radial pulse was palpable after deployment. Other operations were performed sequentially. He had a viable right arm during a 13-month follow-up period. CASE 2: A 25-year-old male was admitted to our hospital due to a motorcycle accident. The ISS was 34 because of a hemothorax and open fractures of the mandible and the left hand. Intraoperative angiography was done through a right femoral artery puncture. Contrast extravasation of the SA was detected just outside the left rib cage. After balloon catheter had been inflated just proximal to the bleeding site, direct surgical exploration was performed through infraclavicular skin incision. The transected SA was identified, and an interposition graft was performed using a saphenous vein graft. Other operations were performed sequentially. He had a viable left arm during a 15-month follow-up period.
CONCLUSION
The challenge of repairing an SA injury can be overcome by using an endovascular approach.

Keyword

Subclavian artery; Vascular system injuries; Endovascular procedures

MeSH Terms

Adult
Angiography
Arm
Arteries
Catheters
Cervical Rib
Clavicle
Constriction
Endovascular Procedures
Femoral Artery
Follow-Up Studies
Fractures, Open
Hand
Hemorrhage
Hemothorax
Humans
Injury Severity Score
Leg
Male
Mandible
Motor Vehicles
Motorcycles
Multiple Trauma*
Nasal Bone
Punctures
Ribs
Saphenous Vein
Scapula
Skin
Spine
Subclavian Artery*
Tibial Arteries
Transplants
Vascular System Injuries
Vertebral Artery