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Siada SS, Dirks RC, Davis JW, O'Banion LA. Endovascular treatment of axillosubclavian arterial injuries is a safe alternative to open repair. Am J Surg 2022; 224:1385-1387. [PMID: 36270818 DOI: 10.1016/j.amjsurg.2022.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/22/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Injuries to the axillosubclavian arteries are rare, comprising 5% of all extremity trauma. This study aims to examine contemporary outcomes of traumatic axillosubclavian injuries. METHODS A retrospective review was performed on patients admitted with innominate, subclavian, and/or axillary artery injuries to a level 1 trauma center from 2011 to 2021. Patients undergoing endovascular repair were compared to those with open repair. RESULTS Thirty two patients met inclusion criteria. Injuries were approached open in 22 (59%) cases and endovascular in 10 (27%). There was no difference in 30-day mortality or hospital length of stay between endovascular and open repair. Endovascular repairs had shorter operative times (1.9 vs 3.1 h, p = 0.009) and lower blood loss (72 vs 1662 mL, p < 0.001). CONCLUSIONS Endovascular repair of axillosubclavian arterial injuries demonstrate similar outcomes to open repair. Significantly shorter operative times and lower blood loss suggest potential decreased morbidity.
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Affiliation(s)
- Sammy S Siada
- Department of Surgery, University of California San Francisco, 2823 Fresno St, Dept of Surgery 1st floor, Fresno, CA, 93721, USA.
| | - Rachel C Dirks
- Department of Surgery, University of California San Francisco, 2823 Fresno St, Dept of Surgery 1st floor, Fresno, CA, 93721, USA.
| | - James W Davis
- Department of Surgery, University of California San Francisco, 2823 Fresno St, Dept of Surgery 1st floor, Fresno, CA, 93721, USA.
| | - Leigh Ann O'Banion
- Department of Surgery, University of California San Francisco, 2823 Fresno St, Dept of Surgery 1st floor, Fresno, CA, 93721, USA. leighann.o'
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Higgins MC, Shi J, Bader M, Kohanteb PA, Brahmbhatt TS. Role of Interventional Radiology in the Management of Non-aortic Thoracic Trauma. Semin Intervent Radiol 2022; 39:312-328. [PMID: 36062226 PMCID: PMC9433159 DOI: 10.1055/s-0042-1753482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Trauma remains a leading cause of death for all age groups, and nearly two-thirds of these individuals suffer thoracic trauma. Due to the various types of injuries, including vascular and nonvascular, interventional radiology plays a major role in the acute and chronic management of the thoracic trauma patient. Interventional radiologists are critical members in the multidisciplinary team focusing on treatment of the patient with thoracic injury. Through case presentations, this article will review the role of interventional radiology in the management of trauma patients suffering thoracic injuries.
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Affiliation(s)
- Mikhail C.S.S. Higgins
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Jessica Shi
- Boston University School of Medicine, Boston, Massachusetts
| | - Mohammad Bader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Paul A. Kohanteb
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Tejal S. Brahmbhatt
- Boston University School of Medicine, Boston, Massachusetts
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care; Boston Medical Center, Boston, Massachusetts
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Zambetti BR, Stuber JD, Patel DD, Lewis RH Jr, Huang DD, Zickler WP, Fischer PE, Magnotti AL, Croce MA, Magnotti LJ. Impact of Endovascular Stenting on Outcomes in Patients with Traumatic Subclavian Artery Injury. J Am Coll Surg 2022; 234:444-9. [PMID: 35290263 DOI: 10.1097/XCS.0000000000000077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Traumatic subclavian artery injury (SAI) remains uncommon but can lead to significant morbidity and mortality. Although open and endovascular repair offer excellent limb salvage rates, their role in blunt and penetrating injuries is not well defined. The goal of this study was to examine the effect of mechanism of injury and type of repair on outcomes in patients with traumatic SAI. STUDY DESIGN Patients undergoing procedures for traumatic SAI were identified from the Trauma Quality Improvement Program database between 2015 and 2018. Demographics, severity of injury and shock, type of subclavian repair (open vs endovascular), morbidity, and mortality were recorded. Patients with SAI were stratified by mechanism and type of repair and compared. Multivariable logistic regression (MLR) analysis was performed to determine independent predictors of mortality. RESULTS Seven hundred thirty-seven patients undergoing procedures for SAI were identified. Of these, 39% were penetrating. The majority were male (80%) with a median age and Injury Severity Score (ISS) of 37 and 21, respectively. 58% of patients were managed endovascularly. For patients with blunt injury, the type of repair affected neither morbidity (25% vs 19%, p = 0.116) nor mortality (11% vs 10%, p = 0.70). For patients with penetrating injuries, endovascular repair had significantly lower morbidity (12% vs 22%, p = 0.028) and mortality (6% vs 21%, p = 0.001). MLR identified endovascular repair as the only modifiable risk factor associated with reduced mortality (odds ratio, 0.35; 95% confidence interval, 0.14 to 0.87, p = 0.02). CONCLUSIONS SAI results in significant morbidity and mortality regardless of mechanism. Although the type of repair did not affect mortality in patients with blunt injury, endovascular repair was identified as the only modifiable predictor of reduced mortality in patients with penetrating injuries.
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Schropp L, de Kleijn RJCMF, Vonken EJ, van Laanen J, Teijink J, Ünlu Ç, Vos FAW, van Hattum ES, Petri BJ, de Borst GJ. Multicenter Case Series and Literature Review on Durability of Stents in the Thoracic Outlet. J Endovasc Ther 2022; 30:355-363. [PMID: 35255758 DOI: 10.1177/15266028221081078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE The aim of this paper was to report our experience with arterial and venous endovascular stent placement in the thoracic outlet (TO) and review available literature. METHODS All patients that underwent arterial or venous stent placement in the TO between 2013 and 2020 in 5 Dutch vascular teaching-hospitals were retrospectively identified. Primary endpoint was symptomatic stent failure due to stenosis, chronic or posture dependent compression, fracture, or occlusion of the stent. Secondary endpoints were symptoms at last follow-up and re-interventions. For the literature review, we searched studies reporting on stenting in the TO. RESULTS Twenty-six patients were included with 11 arterial and 15 venous stents implanted to treat angioplasty resistant stenosis in arterial or venous TO syndrome, iatrogenic or traumatic vascular injury, radiotherapy fibrosis, or arterial dissection. Median follow-up was 19 and 14 months in the arterial and venous-group, respectively. Eight (73%) patients in the arterial, and 9 (60%) in the venous-group suffered symptomatic stent failure. Seven (64%) patients in the arterial, and 9 (60%) in the venous-group required at least 1 re-intervention. When comparing all patients with stent placement after TO decompression (TOD) to patients without, there were substantially more symptomatic stent failures and re-interventions required in the patients without TOD. Six patients (54%) in the arterial-group and 11 (73%) in the venous-group were symptom-free at last follow-up. Five articles describing 51 patients with arterial and 6 articles describing 81 patients with venous stents were included in the literature review. In the arterial-group, no TOD prior to stent placement was performed, while in the venous-group all but 1 article performed TOD prior to stent placement. Results showed comparable rates of symptomatic stent failure (24% vs 30%), and patients requiring re-interventions (29% vs 21%) between groups. CONCLUSION Based on our multicenter series and review, stents in the TO have a considerable risk of failure, both in the venous and the arterial territory. Especially in patients without TOD: the need for re-interventions is high and half the patients eventually undergo TOD. Based on the currently available data, stenting in the TO should be applied cautiously while TOD should be considered.
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Affiliation(s)
- Ludo Schropp
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Evert-Jan Vonken
- Department of Interventional Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jorinde van Laanen
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joep Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Çagdas Ünlu
- Department of Vascular Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Floris A W Vos
- Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - Eline S van Hattum
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bart-Jeroen Petri
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Zhang J, Basu R, Bauder AR, Quatramoni JG, Glaser J, Kalapatapu V, Gaffey AC. Endovascular repair of traumatic axillosubclavian artery injuries. J Vasc Surg Cases Innov Tech 2022; 8:23-27. [PMID: 35036668 PMCID: PMC8743185 DOI: 10.1016/j.jvscit.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022] Open
Abstract
Gun violence reached a 20-year peak in 2020, with the first-line treatment of axillosubclavian vascular injuries (SAVIs) remaining unknown. Traditional open exposure is difficult and exposes patients to iatrogenic venous and brachial plexus injury. The practice of endovascular treatment has been increasing. We performed a retrospective analysis of SAVIs at a level I trauma center. Seven patients were identified. Endovascular repair was performed in five patients. Technical success was 100%. The early results suggest that endovascular treatment of trauma-related SAVIs can be performed safely and effectively. However, complications such as stent thrombosis or occlusion can occur, demonstrating the need for surveillance.
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Affiliation(s)
- Jason Zhang
- Division of Vascular and Endovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Rohan Basu
- Division of Vascular and Endovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Andrew R. Bauder
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | | | - Julia Glaser
- Division of Vascular and Endovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Venkat Kalapatapu
- Division of Vascular and Endovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Ann C. Gaffey
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Diego, School of Medicine, La Jolla, Calif
- Correspondence: Ann C. Gaffey, MD, MS, Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Diego, School of Medicine, 9434 Medical Center Dr, Mail Code 7403, La Jolla, CA 92037
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Boggs HK, Tomihama RT, Abou-Zamzam AM, Mukherjee K, Turay D, Teruya TH, Magtanong E, Pop A, Kiang SC. Analysis of Traumatic Axillo-Subclavian Vessel Injuries: Endovascular Management is a Viable Option to Open Surgical Reconstruction. Ann Vasc Surg 2021; 79:25-30. [PMID: 34656717 DOI: 10.1016/j.avsg.2021.07.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 06/14/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND In traumatic axillo-subclavian vessel injuries, endovascular repair has been increasingly described, despite ongoing questions regarding infection risk and long-term durability. We sought to compare the clinical and safety outcomes between endovascular and surgical treatment of traumatic axillo-subclavian vessel injuries. METHOD A search query of the prospectively maintained PROOVIT registry for patients older than 18 years of age with a diagnosis of axillary or subclavian vessel injury between 2014-2019 was performed at a Level 1 Trauma Center. Patient demographics, severity of injury, Mangled Extremity Severity Score (MESS), Injury Severity Score (ISS), procedural interventions, complications, and patency outcomes were collected and analyzed. RESULTS Twenty-three patients with traumatic axillo-subclavian vessel injuries were included. There were similar rates of penetrating and blunt injuries (48% vs. 52%, respectively). Eighteen patients (78%) underwent intervention: 11 underwent endovascular stenting or diagnostic angiography; 7 underwent open surgical repair. There was similar severity of arterial injuries between the endovascular and open surgical groups: transection (30% vs. 40%, respectively), occlusion (30% vs. 40%, respectively). The open surgical group had worse initial clinical comorbidities: higher ISS scores (17.0 vs 13.5, p = 0.034), higher median MESS scores (6 vs. 3.5, P = 0.001). The technical success for the endovascular group was 100%. The endovascular group had a lower estimated procedural blood loss (27.5 mL vs. 624 mL, P = 0.03). The endovascular arterial group trended toward a shorter length of hospital stay (5.6 days vs. 27.6 days, P = 0.09) and slightly reduced procedural time (191.0 min vs. 223.5 min, P = 0.165). Regarding imaging follow up (average of 60 days post-discharge), 7 patients (54%) underwent surveillance imaging (5 with duplex ultrasound, 2 with computed tomography angiography CTA) that demonstrated 100% patency. Regardless of ISS or MESS scores, at long term clinical follow up (average of 214 days), there were no limb losses, graft infections or vascular complications in either the endovascular or open surgical group. CONCLUSIONS Endovascular treatment is a viable option for axillo-subclavian vessel injuries. Preliminary results demonstrate that endovascular treatment, when compared to open surgical repair, can have similar rates of technical success and long-term outcomes in patency, infection and vascular complications.
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Affiliation(s)
- Hans K Boggs
- Loma Linda University Medical Center, Loma Linda, CA. Department of Surgery, Division of Vascular and Endovascular Surgery
| | - Roger T Tomihama
- Loma Linda University Medical Center, Loma Linda, CA. Department of Surgery, Division of Vascular and Endovascular Surgery; Loma Linda Univeristy Medical Center, Loma Linda, CA Department of Radiology, Division of Interventional Radiology
| | - Ahmed M Abou-Zamzam
- Loma Linda University Medical Center, Loma Linda, CA. Department of Surgery, Division of Vascular and Endovascular Surgery
| | - Kaushik Mukherjee
- Loma Linda University Medical Center, Loma Linda, CA. Department of Surgery, Division of Vascular and Endovascular Surgery
| | - David Turay
- Loma Linda University Medical Center, Loma Linda, CA. Department of Surgery, Division of Vascular and Endovascular Surgery
| | - Theodore H Teruya
- Loma Linda University Medical Center, Loma Linda, CA. Department of Surgery, Division of Vascular and Endovascular Surgery; Loma Linda Veteran's Administration, Loma Linda, CA. Department of Surgery, Division of Vascular and Endovascular Surgery
| | | | - Andrew Pop
- Loma Linda University School of Medicine, Loma Linda, CA
| | - Sharon C Kiang
- Loma Linda University Medical Center, Loma Linda, CA. Department of Surgery, Division of Vascular and Endovascular Surgery; Loma Linda Veteran's Administration, Loma Linda, CA. Department of Surgery, Division of Vascular and Endovascular Surgery.
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Ben Mrad I, Ben Fatma L, Ben Mrad M, Miri R, Mleyhi S, Mami I, Zairi I, Denguir R. Endovascular Management of a Subclavian Arterial Injury During Central Venous Catheter Placement for Hemodialysis. Open Access Emerg Med 2021; 13:273-277. [PMID: 34194247 PMCID: PMC8238546 DOI: 10.2147/oaem.s308233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022] Open
Abstract
Subclavian artery injuries after central venous catheter placement constitute a rare but potentially fatal complication. The surgical repair of a subclavian artery trauma is a real challenge, associated with a high rate of morbidity and mortality. The role of endovascular treatment for vascular trauma, including injury to the subclavian artery, continues to evolve. In this manuscript, we report the case of an urgent endovascular repair by a covered stent graft of a subclavian artery perforation following the placement of a central venous catheter for dialysis in a 52-year-old patient, having a chronic kidney failure stage 5, with multiple comorbidities. The present case suggests that attention needs to be paid to preventing iatrogenic arterial cannulation during central vein catheterization to avoid potentially devastating complications. Endovascular treatment using a covered stent should be attempted as a first-line therapeutic option.
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Affiliation(s)
| | | | - Melek Ben Mrad
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
| | - Rim Miri
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
| | - Sobhy Mleyhi
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
| | - Ikram Mami
- Nephrology Department, Rabta Hospital, Tunis, Tunisia
| | - Ihsen Zairi
- Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Raouf Denguir
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
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Asensio JA, Dabestani PJ, Miljkovic SS, Wenzl FA, Kessler JJ, Kalamchi LD, Kotaru TR, Agrawal DK. Traumatic penetrating arteriovenous fistulas: a collective review. Eur J Trauma Emerg Surg 2021; 48:775-789. [PMID: 33386864 DOI: 10.1007/s00068-020-01574-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/07/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Traumatic penetrating arteriovenous fistulas (AVFs) are very rare. The majority of these injuries occur secondary to penetrating trauma. Objectives of this study: review their incidence, clinical presentation, radiologic identification, management, complications and outcomes. METHODS A literature search was performed on MEDLINE Complete-Pubmed from 1829-2019. PRISMA guidelines were utilized. Of 305 potentially eligible articles, 201 articles were selected. INCLUSION CRITERIA patients age ≥ 18, articles with title and abstract in English, AVFs secondary to penetrating trauma, articles which specified vessels involved in AVFs, and those reporting complete information on patient presentation, diagnosis, imaging, surgical and/or endovascular surgical management, and outcomes of penetrating AVF's. EXCLUSION CRITERIA articles reporting blunt or iatrogenic AVFs, pediatric patients, fistulas used for dialysis and their complications, articles lacking complete information, cranial/spinal AVFs or cardiac AVFs, and duplicate articles. Mechanism of injury (MOI), diagnosis, involved vessels, management and outcomes of patients with AVFs secondary to penetrating trauma were recorded. RESULTS There were a total of 291 patients with AVFs secondary to penetrating injuries. Mechanism of injury (MOI): stab wounds (SW)-126 (43.3%), Gunshot wounds (GSW)-94 (32.3%), miscellaneous-35 (12%), mechanism unspecified-36 (12.4%). Anatomic area: neck-69 (23.7%) patients, thorax-46 (15.8%), abdomen-87 (30%), upper and lower extremities-89 (30.6%). Most commonly involved vessels-vertebral artery-38 (13%), popliteal vein-32 (11.7%). Angiography was diagnostic-265 patients (91.1%). INTERVENTIONS Surgical- 202 (59.6%), Endovascular-118 (34.8%). Associated: aneurysms/pseudoaneurysms-129 (44.3%). CONCLUSION Most AVFs occur secondary to penetrating injuries. Stab wounds account for the majority of these injuries. Most frequently injured vessels are vertebral artery and superficial femoral vein. Surgical interventions are the most common mode of management followed by endovascular surgical techniques.
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Affiliation(s)
- Juan A Asensio
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA.
| | - Parinaz J Dabestani
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Stephanie S Miljkovic
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Florian A Wenzl
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - John J Kessler
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Louay D Kalamchi
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Tharun R Kotaru
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Devendra K Agrawal
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
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Tadayon N, Yavari N, Zarrintan S, Hosseini SM, Kalantar-Motamedi SMR. Management of traumatic subclavian artery injuries in a high-volume vascular surgery center in Iran. J Cardiovasc Thorac Res 2020; 12:145-149. [PMID: 32626556 PMCID: PMC7321003 DOI: 10.34172/jcvtr.2020.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 01/30/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: Subclavian artery injury is an uncommon vascular trauma with potential morbidity and mortality. Management of subclavian artery trauma requires open and endovascular techniques and timely and efficacious decision is mandatory. We retrospectively reviewed traumatic subclavian artery injuries in a high-volume vascular surgery center in Iran.
Methods: In a retrospective study, we assessed subclavian artery injuries during 6 years in ShohadaTajrish Medical Center. Background characteristics, type of incision, type of operation and outcome of patients were evaluated.
Results: A total of 14 patients had subclavian artery injury (mean age 29.9 ± 13.4 years, 92.9% male). Trauma was in left and right sides in eight (57.1%) and six patients (42.9%) respectively. Arteriorrhaphy, interposition and ligation of injured artery was done in 7 (50.0%), 3 (21.4%) and 4 (28.6%) patients respectively. Associated nerve injury was present in six patients (42.9%). Endovascular proximal control was obtained in six patients (42.9%) prior to vascular exposure. Time of patient referral did not have significant association with shock or type of operation (P > 0.05).
Conclusion: Although traumatic subclavian artery injuries are rare, its vascular exposures and reconstructions are of potential clinical concern. Endovascular interventions can facilitate proximal control. In addition, endovascular repair by covered stent is an alternative to open surgery.
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Affiliation(s)
- Niki Tadayon
- Division of Vascular & Endovascular Surgery, Department of General & Vascular Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Iranian Society of Vascular Surgery, Tehran, Iran
| | - Negin Yavari
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Zarrintan
- Division of Vascular & Endovascular Surgery, Department of General & Vascular Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Iranian Society of Vascular Surgery, Tehran, Iran.,Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Masoud Hosseini
- Division of Vascular & Endovascular Surgery, Department of General & Vascular Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Iranian Society of Vascular Surgery, Tehran, Iran
| | - Seyed Moahammad Reza Kalantar-Motamedi
- Division of Vascular & Endovascular Surgery, Department of General & Vascular Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Iranian Society of Vascular Surgery, Tehran, Iran
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10
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Abstract
A 47-year-old male police officer presented at an outpatients consulting room complaining of exertional dyspnea and swelling and pain in the right arm. He had suffered a perforating gunshot wound of the right infraclavicular region 7 months previously. A chest tomography showed considerable dilatation of the subclavian and cervical veins and veins of the right upper limb, with no clear point of arteriovenous communication. His symptoms exacerbated and he was admitted to hospital before the date scheduled for treatment. He underwent endovascular treatment with an 8x100 mm Fluency covered stent that was placed in the right subclavian artery using the through-and-through technique. Control angiography showed that the fistulous defect had been completely sealed. There was significant relief of the symptoms on the first day after the operation. Traumatic lesions of the subclavian artery are rare, but can be associated with high morbidity and mortality rates. Penetrating trauma is the main cause and arteriovenous fistulas should be ruled out when evaluating penetrating injuries in vascular territories.
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Affiliation(s)
- José Júlio Bechir Maués
- Hospital Saúde da Mulher - HSM, Departamento de Cirurgia Vascular e Endovascular, Belém, PA, Brasil
| | - Heather Lynn Hauter
- Hospital Saúde da Mulher - HSM, Departamento de Cirurgia Vascular e Endovascular, Belém, PA, Brasil
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Maskanakis A, Patelis N, Moris D, Tsilimigras DI, Schizas D, Diakomi M, Bakoyiannis C, Georgopoulos S, Klonaris C, Liakakos T. Stenting of Subclavian Artery True and False Aneurysms: A Systematic Review. Ann Vasc Surg 2018; 47:291-304. [DOI: 10.1016/j.avsg.2017.08.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/18/2017] [Accepted: 08/22/2017] [Indexed: 12/12/2022]
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12
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Waller CJ, Cogbill TH, Kallies KJ, Ramirez LD, Cardenas JM, Todd SR, Chapman KJ, Beckman MA, Sperry JL, Anto VP, Eriksson EA, Leon SM, Anand RJ, Pearlstein M, Capano-Wehrle L, Cothren Burlew C, Fox CJ, Cullinane DC, Roberts JC, Harrison PB, Berg GM, Haan JM, Lightwine K. Contemporary management of subclavian and axillary artery injuries-A Western Trauma Association multicenter review. J Trauma Acute Care Surg 2017; 83:1023-31. [PMID: 28715360 DOI: 10.1097/TA.0000000000001645] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Subclavian and axillary artery injuries are uncommon. In addition to many open vascular repairs, endovascular techniques are used for definitive repair or vascular control of these anatomically challenging injuries. The aim of this study was to determine the relative roles of endovascular and open techniques in the management of subclavian and axillary artery injuries comparing hospital outcomes, and long-term limb viability. METHODS A multicenter, retrospective review of patients with subclavian or axillary artery injuries from January 1, 2004, to December 31, 2014, was completed at 11 participating Western Trauma Association institutions. Statistical analysis included χ, t-tests, and Cochran-Armitage trend tests. A p value less than 0.05 was significant. RESULTS Two hundred twenty-three patients were included; mean age was 36 years, 84% were men. An increase in computed tomography angiography and decrease in conventional angiography was observed over time (p = 0.018). There were 120 subclavian and 119 axillary artery injuries. Procedure type was associated with injury grade (p < 0.001). Open operations were performed in 135 (61%) patients, including 93% of greater than 50% circumference lacerations and 83% of vessel transections. Endovascular repairs were performed in 38 (17%) patients; most frequently for pseudoaneurysms. Fourteen (6%) patients underwent a hybrid procedure. Use of endovascular versus open procedures did not increase over the duration of the study (p = 0.248). In-hospital mortality rate was 10%. Graft or stent thrombosis occurred in 7% and graft or stent infection occurred in 3% of patients. Mean follow-up was 1.6 ± 2.4 years (n = 150). Limb salvage was achieved in 216 (97%) patients. CONCLUSION The management of subclavian and axillary artery injuries still requires a wide variety of open exposures and procedures, especially for the control of active hemorrhage from more than 50% vessel lacerations and transections. Endovascular repairs were used most often for pseudoaneurysms. Low early complication rates and limb salvage rates of 97% were observed after open and endovascular repairs. LEVEL OF EVIDENCE Prognostic/epidemiologic, level IV.
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Branco BC, DuBose JJ. Endovascular solutions for the management of penetrating trauma: an update on REBOA and axillo-subclavian injuries. Eur J Trauma Emerg Surg 2016; 42:687-94. [PMID: 27853843 DOI: 10.1007/s00068-016-0739-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Endovascular procedures continue to gain acceptance as management options for penetrating traumatic injuries. Currently, several areas of potential endovascular application are being investigated. However, the bulk of the literature on this topic is still limited to case series or small retrospective studies. Therefore, we performed a review of the published experience involving the application of endovascular therapy to trauma patients who have sustained penetrating injuries with focus on outcomes of resuscitative endovascular balloon occlusion of the aorta (REBOA) and endovascular repair of axillo-subclavian injuries. METHODS Published case reports, retrospective and prospective studies of REBOA and axillo-subclavian injuries were systematically reviewed. RESULTS A total of 7 studies on REBOA and 10 studies on endovascular repair of axillo-subclavian injuries were included. Overall, REBOA was used as an adjunct for hemorrhage control and resuscitation in patients at risk of cardiopulmonary arrest, preventing further cardiovascular collapse successfully. For axillo-subclavian injuries, endovascular stent placement had efficacy comparable to the traditional open repair. CONCLUSION REBOA is a safe and effective alternative to open thoracotomy in critically ill trauma patients at risk of death due to torso hemorrhage. Endovascular repair outcomes are comparable to open repair after axillo-subclavian injuries. Long-term results of endovascular repair remain to be defined in this patient population.
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Abstract
Penetrating injury to the neck has inspired considerable controversy with regard to its management, owing to the large number of important, susceptible structures contained in this area. Mandatory exploration of all wounds has generally given way to selective operative management. Clinical assessment has, once again, become the prime diagnostic tool. This review describes the evolution of management and the value of various diagnostic modalities. It concludes with a summary of appropriate operative techniques.
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Affiliation(s)
- Campbell MacFarlane
- Emergency Medical Services Training, Gauteng Provincial Government Department of Health and Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Carol Ann Benn
- Chris Hani Baragwanath Hospital, Johannesburg and Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Abstract
Last century saw a marked increase in vascular injuries and their treatment has been improved from the experience gained in the major conflicts in the latter half of the last century. This trend of increasing numbers of vascular injuries has been perpetuated by a rise in civilian violence. This article reviews the mechanisms, diagnosis and treatment of vascular injury and outlines some of the advances in endovascular techniques for treating vascular trauma.
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Affiliation(s)
- DP Strong
- Selly Oak Hospital, University Hospitals Birmingham NHS Trust, UK,
| | - AT Edwards
- Selly Oak Hospital, University Hospitals Birmingham NHS Trust, UK
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16
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Abstract
The purpose of this paper is to report a case of axillary artery aneurysm, successfully treated by percutaneous transfemoral self-expandable polytetrafluoroethylene (PTFE) covered Wallgraft™ stent. A 20-year-old man presented with sudden-onset, severe aching pain of left upper limb that occurred while doing isometric exercise. He had feeble left brachial and radial pulses. Angiography revealed a 21 x 14 mm left axillary artery aneurysm with a 15 mm neck. There was an organized clot in the midpart of the left brachial artery. The aneurysm was successfully closed with a self-expandable 10 x 30 mm Wallgraft™ endoprosthesis PTFE graft stent, via the right femoral route. A check angiogram at 6 weeks of follow-up showed a patent stent with no endovascular leak. At 1 year of follow-up, the patient was asymptomatic with normal upper limbs pulsations. Axillary artery aneurysm may be treated with a stent graft, which is an effective, rapid, and definite treatment and is an acceptable alternative to standard open surgical repair.
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Affiliation(s)
- Rajesh Vijayvergiya
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India.
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Evans T, Roy S, Rocker M. Subclavian Artery Pseudoaneurysm Formation 3 Months after a Game of Rugby Union. Case Rep Emerg Med 2015; 2015:346192. [PMID: 26351589 DOI: 10.1155/2015/346192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 11/24/2022] Open
Abstract
Pseudoaneurysms of the subclavian artery remain a rare complication after fracture of the clavicle. We report a case of delayed diagnosis of a subclavian artery pseudoaneurysm after a closed fracture of the clavicle in a 15-year-old patient, 3 months after the original injury while playing rugby union. Despite several attendances to the Emergency Department with vague symptoms, the final diagnosis was confirmed by duplex ultrasound and Computed Tomography of the thorax. Surgical repair was indicated due to acute limb ischaemia from distal embolisation from a large pseudoaneurysm, with the patient making a full recovery. This case highlights the need for clinical vigilance when assessing patients, particularly on repeated occasions when their recovery appears to be impaired. A thorough history and clinical examination can raise suspicion of even rare occurrences and aid prompt management.
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Abstract
AIM To summarize the experience of endovascular treatment of traumatic arteriovenous fistulae. MATERIAL AND METHODS Endovascular interventions for arteriovenous fistulae of different locations were applied in 16 patients aged 19 to 83 years (mean 50.4±14.3) in A.V. Vishnevskiy Institute of Surgery from 2003 to 2014. Among causes there were stab wounds, gunshot wounds, blunt trauma, iatrogenic. Different endovascular methods including stenting with self-opening and balloon-expanding stent-grafts, embolic coils and occluders implantation were used. RESULTS Pain syndrome, disorders of support function and trophic changes were observed in patients with arteriovenous fistulae more localized more distal than lower one third of the thigh. More proximally located arteriovenous fistulae regardless of their diameter resulted severe heart failure and portal hypertension. Angiographic and clinical success was achieved in 100% of cases. Manifestations of heart failure and portal hypertension disappeared in all patients after endovascular interventions. Also support function restored, pain and trophic disorders were cured. CONCLUSION Arteriovenous fistulae regardless of their size, location and time of existence must be dissociated. Prolonged arteriovenous shunting leads to severe heart failure. Current technologies and tools used in endovascular interventions provide reliable dissociation of arteriovenous fistulae even in case of difficult anatomical features.
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Affiliation(s)
- V N Tsygankov
- A.V. Vishnevskiy Institute of Surgery, I.M. Sechenov First Moscow State Medical University, Russian Ministry of Health
| | - A M Frantsevich
- A.V. Vishnevskiy Institute of Surgery, I.M. Sechenov First Moscow State Medical University, Russian Ministry of Health
| | - A B Varava
- A.V. Vishnevskiy Institute of Surgery Russian Ministry of Health
| | - V N Dan
- A.V. Vishnevskiy Institute of Surgery Russian Ministry of Health
| | - N R Chernaya
- N.V. Sklifosovskiy Research Institute for Emergency Care, Department of Health, Moscow, Russia
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Kang BW, BAE JH, Chung JW, Jo BJ, Park JG, Nah DY. Urgent Endovascular Stent Graft Placement for Iatrogenic Subclavian Artery Rupture. Journal of Trauma and Injury 2015. [DOI: 10.20408/jti.2015.28.2.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Byung-Woo Kang
- Division of Cardiology, Department of Internal Medicine, Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Jun-ho BAE
- Division of Cardiology, Department of Internal Medicine, Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Jin-Wook Chung
- Division of Cardiology, Department of Internal Medicine, Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Byeong-Joo Jo
- Division of Cardiology, Department of Internal Medicine, Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Jun-Gi Park
- Division of Cardiology, Department of Internal Medicine, Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Deuk-Young Nah
- Division of Cardiology, Department of Internal Medicine, Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
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Oliveira N, Alves G, Rodrigues H, Gonçalves FB, Martins J, Morais JA, Ferreira ME, Castro JA, Capitão LM. Endovascular treatment of blunt traumatic injuries of the subclavian and axillary arteries. Angiologia e Cirurgia Vascular 2014. [DOI: 10.1016/j.ancv.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kalish J, Nguyen T, Hamburg N, Eberhardt R, Rybin D, Doros G, Farber A. Associated venous injury significantly complicates presentation, management, and outcomes of axillosubclavian arterial trauma. Int J Angiol 2013; 21:217-22. [PMID: 24293980 DOI: 10.1055/s-0032-1330969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Axillosubclavian vessel injury (ASVI) is associated with high morbidity and mortality. Most studies are single-center experiences of small numbers of patients with penetrating injury. We assessed 21st-century presentation and management of ASVI and focused on outcomes of combined arterial/venous injury. We reviewed the National Trauma Data Bank for patients with isolated arterial ASVI (group 1) and combined arterial/venous ASVI (group 2). Demographics, injury severity parameters, interventions, complications, and outcomes were compared. We identified 581 patients with ASVI (mean age 35.1; 88.1% male), with 466 isolated arterial injuries and 115 combined arterial/venous injuries. Group 2 had lower presenting systolic blood pressure and Glasgow Coma Scale, and had higher rates of operative repair (55.7 vs. 43.1%, p = 0.016) and higher mortality (33.9 vs. 13.9%, p < 0.001). There were no differences in amputation (5.2 vs. 2.4%, p = 0.121), compartment syndrome (2.6 vs. 1.9%, p = 0.713), and deep vein thrombosis (0.9 vs. 0.2%, p = 0.357). When separated by mechanism of injury, combined injuries from blunt trauma did increase amputation rates (27.8 vs. 4.2%, p = 0.002). Multivariate analysis revealed that combined arterial/venous injury significantly increased risk of death (odds ratio [OR], 2.99; confidence interval [CI], 1.73 to 5.17; p = 0.0001). Penetrating injury had higher odds of death than blunt injury (OR, 1.96; CI, 1.03 to 3.73; p = 0.041). ASVI is rare but extremely lethal. Concomitant venous and arterial injury is not associated with worse limb-related outcomes, except in blunt injuries and resultant amputations, but is associated with a threefold increase in mortality rates compared with isolated arterial injury.
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Affiliation(s)
- Jeffrey Kalish
- Division of Vascular and Endovascular Surgery, Boston University Medical Center, Boston, Massachusetts
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Rossi UG, Petrocelli F, Ferro C. Subclavian artery pseudoaneurysm complicating central venous catheterization. Catheter Cardiovasc Interv 2013; 82:E906-10. [DOI: 10.1002/ccd.24796] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 12/03/2012] [Accepted: 12/23/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Umberto G. Rossi
- Department of Radiology and Interventional Radiology; IRCCS San Martino University Hospital - IST - National Institute for Cancer Research; Largo Rosanna Benzi 10 16132 Genova Italy
| | - Francesco Petrocelli
- Department of Radiology and Interventional Radiology; IRCCS San Martino University Hospital - IST - National Institute for Cancer Research; Largo Rosanna Benzi 10 16132 Genova Italy
| | - Carlo Ferro
- Department of Radiology and Interventional Radiology; IRCCS San Martino University Hospital - IST - National Institute for Cancer Research; Largo Rosanna Benzi 10 16132 Genova Italy
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Ahn KS, Kang KJ, Kim HT, Kim YH, Park UJ, Lim TJ, Park TJ, Cho WH. Living-Donor Liver Transplant With an Interposition Graft of the Inferior Vena Cava for Hepatocellular Carcinoma: Beyond the Milan Criteria and Within the UCSF Criteria. EXP CLIN TRANSPLANT 2013; 11:283-6. [DOI: 10.6002/ect.2012.0133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Wong VW, Gordy SD, Schreiber M, Tieu BH. Penetrating neck injury to the superior thoracic artery managed by video-assisted thoracoscopic surgery. Case Rep Surg 2013; 2013:413462. [PMID: 23476874 DOI: 10.1155/2013/413462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 01/09/2013] [Indexed: 11/17/2022] Open
Abstract
Penetrating trauma to the axillary artery and its branches is uncommon and associated with high morbidity and mortality. Open exploration is mandated in hemodynamically unstable patients, but surgical exposure can be difficult due to the concentration of vital structures and complex anatomy in this region. Computed tomographic angiography is a potential diagnostic modality in hemodynamically stable patients. In these patients, endovascular therapies may provide a feasible means of controlling hemorrhage while minimizing surgical complications. A high incidence of concomitant intrathoracic injury has resulted in an expanding role for video-assisted thoracoscopic surgery. In this paper, we present a case of penetrating injury to the superior thoracic artery that was not amenable to endovascular therapy and was ultimately managed with thoracoscopic surgery.
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Yi NJ, Suh KS, Suh SW, Chang YR, Hong G, Yoo T, Kim H, Park MS, Choi YR, Lee KW, Jung CW, Lee JH, Kim YJ, Yoon JH, Lee HS. Excellent Outcome in 238 Consecutive Living Donor Liver Transplantations Using the Right Liver Graft in a Large Volume Single Center. World J Surg 2013; 37:1419-29. [DOI: 10.1007/s00268-013-1976-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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DuBose JJ, Rajani R, Gilani R, Arthurs ZA, Morrison JJ, Clouse WD, Rasmussen TE. Endovascular management of axillo-subclavian arterial injury: a review of published experience. Injury 2012; 43:1785-92. [PMID: 22921384 DOI: 10.1016/j.injury.2012.08.028] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 08/03/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND The role of endovascular treatment for vascular trauma, including injury to the subclavian and axillary arteries, continues to evolve. Despite growing experience with the utilization of these techniques in the setting of artherosclerotic and aneurysmal disease, published reports in traumatic subclavian and axillary arterial injuries remain confined to sporadic case reports and case series. METHODS We conducted a review of the medical literature from 1990 to 2012 using Pubmed and OVID Medline databases to search for all reports documenting the use of endovascular stenting for the treatment of subclavian or axillary artery injuries. Thirty-two published reports were identified. Individual manuscripts were analysed to abstract data regarding mechanism, location and type of injury, endovascular technique and endograft type utilized, follow-up, and radiographic and clinical outcomes. RESULTS The use of endovascular stenting for the treatment of subclavian (150) or axillary (10) artery injuries was adequately described for only 160 patients from 1996 to the present. Endovascular treatment was employed after penetrating injury (56.3%; 29 GSW; 61 SW), blunt trauma (21.3%), iatrogenic catheter-related injury (21.8%) and surgical injury (0.6%). Injuries treated included pseudoaneurysm (77), AV fistula (27), occlusion (16), transection (8), perforation (22), dissection (6), or other injuries otherwise not fully described (4). Initial endovascular stent placement was successful in 96.9% of patients. Radiographic and clinical follow-up periods ranging from hospital discharge to 70 months revealed a follow-up patency of 84.4%. No mortalities related to endovascular intervention were reported. New neurologic deficits after the use of endovascular modalities were reported in only one patient. CONCLUSION Endovascular treatment of traumatic subclavian and axillary artery injuries continues to evolve. Early results are promising, but experience with this modality and data on late follow-up remain limited. Additional multicenter prospective study and capture of data for these patients is warranted to further define the role of this treatment modality in the setting of trauma.
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Affiliation(s)
- Joseph J DuBose
- University of Maryland Medical System, R Adams Cowley Shock Trauma Center, United States Air Force Baltimore Center for the Sustainment of Trauma and Readiness Skills, United States:
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Assenza M, Centonze L, Valesini L, Campana G, Corona M, Modini C. Traumatic subclavian arterial rupture: a case report and review of literature. World J Emerg Surg 2012; 7:18. [PMID: 22710070 PMCID: PMC3447637 DOI: 10.1186/1749-7922-7-18] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 06/18/2012] [Indexed: 11/14/2022] Open
Abstract
Subclavian artery injuries represent an uncommon complication of blunt chest trauma, this structure being protected by subclavius muscle, the clavicle, the first rib, and the deep cervical fascia as well as the costo-coracoid ligament, a clavi-coraco-axillary fascia portion. Subclavian artery injury appears early after trauma, and arterial rupture may cause life-treatening haemorrages, pseudo-aneurysm formation and compression of brachial plexus. These clinical eveniences must be carefully worked out by accurate physical examination of the upper limb: skin color, temperature, sensation as well as radial pulse and hand motility represent the key points of physical examination in this setting. The presence of large hematomas and pulsatile palpable mass in supraclavicular region should raise the suspicion of serious vascular injury. Since the first reports of endovascular treatment for traumatic vascular injuries in the 90’s, an increasing number of vascular lesions have been treated this way. We report a case of traumatic subclavian arterial rupture after blunt chest trauma due to a 4 meters fall, treated by endovascular stent grafting, providing a complete review of the past twenty years’ literature.
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Affiliation(s)
- Marco Assenza
- Emergency Department, Division of Emergency Surgery and Trauma, Policlinico "Umberto I", Rome, Italy.
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Shalhub S, Starnes BW, Hatsukami TS, Karmy-jones R, Tran NT. Repair of Blunt Thoracic Outlet Arterial Injuries: An Evolution From Open to Endovascular Approach. ACTA ACUST UNITED AC 2011; 71:E114-21. [DOI: 10.1097/ta.0b013e31822cf359] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shalhub S, Starnes BW, Tran NT. Endovascular treatment of axillosubclavian arterial transection in patients with blunt traumatic injury. J Vasc Surg 2011; 53:1141-4. [PMID: 21276694 DOI: 10.1016/j.jvs.2010.10.129] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 10/29/2010] [Accepted: 10/30/2010] [Indexed: 11/28/2022]
Abstract
Axillosubclavian arterial transection due to blunt traumatic injury poses a treatment challenge in the multiply injured patient. Endovascular repair can be technically successful if the injury is focal. We describe an endovascular technique utilizing combined brachial and femoral access to create a through-and-through brachial-femoral wire and repair the arterial injury with a covered stent.
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Affiliation(s)
- Sherene Shalhub
- University of Washington, Harborview Medical Center, Department of Surgery, Division of Vascular Surgery, 325 9th Ave, Box 359796, Seattle, WA 98104, USA
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Lee GS, Brawley J, Hung R. Complex subclavian artery pseudoaneurysm causing failure of endovascular stent repair with salvage by percutaneous thrombin injection. J Vasc Surg 2010; 52:1058-60. [DOI: 10.1016/j.jvs.2010.05.085] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 02/24/2010] [Accepted: 05/15/2010] [Indexed: 10/19/2022]
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Weger N, Klaassen Z, Sturt C, Hertz S. Endovascular Treatment of a Pseudoaneurysm After an Iatrogenic Axillary Artery Injury. Ann Vasc Surg 2010; 24:826.e9-12. [PMID: 20471203 DOI: 10.1016/j.avsg.2009.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 10/31/2009] [Accepted: 12/20/2009] [Indexed: 11/24/2022]
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Sobnach S, Nicol A, Nathire H, Edu S, Kahn D, Navsaria P. An Analysis of 50 Surgically Managed Penetrating Subclavian Artery Injuries. Eur J Vasc Endovasc Surg 2010; 39:155-9. [DOI: 10.1016/j.ejvs.2009.10.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 10/17/2009] [Indexed: 11/25/2022]
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Carrick MM, Morrison CA, Pham HQ, Norman MA, Marvin B, Lee J, Wall MJ, Mattox KL. Modern management of traumatic subclavian artery injuries: a single institution's experience in the evolution of endovascular repair. Am J Surg 2010; 199:28-34. [PMID: 19520356 DOI: 10.1016/j.amjsurg.2008.11.031] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 11/21/2008] [Accepted: 11/21/2008] [Indexed: 11/20/2022]
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Melas N, Saratzis A, Saratzis N, Kiskinis D. Endovascular repair of inadvertent subclavian artery perforation during cannulation for dialysis access: case report and review of the literature: . Eur J Emerg Med 2009; 16:323-6. [DOI: 10.1097/mej.0b013e32832a0851] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hershberger RC, Aulivola B, Murphy M, Luchette FA. Endovascular grafts for treatment of traumatic injury to the aortic arch and great vessels. ACTA ACUST UNITED AC 2009; 67:660-71. [PMID: 19741416 DOI: 10.1097/TA.0b013e3181b2894c] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Treatment of traumatic vascular injury using endovascular techniques has evolved as endovascular capabilities have advanced over the past several decades. Several endovascular techniques have been employed to address the challenges of traumatic arterial injury, including coil embolization and the use of stents, which may be either bare metal or covered with graft material. Compared with traditional surgical repair, endovascular stent grafting for the repair of traumatic arterial injury offers the advantage of decreased morbidity because a remote access site may be used, avoiding surgical dissection and lengthy operating times. METHODS A Medline (1995-2007) search was performed to find all studies discussing the use of endovascular means to treat supradiaphragmatic arterial trauma. RESULTS In this review of 195 studies published between January 1995 and December 2007, the overall technical success rate of endovascular treatment of supradiaphragmatic arterial injury was 96.7%, and the complication rate was 6.4%. CONCLUSION The results of this review suggest a potential morbidity and mortality benefit over traditional open repair; however, long-term data are lacking. Long-term follow-up for stent durability is of particular concern in the trauma population, which tends to comprise younger patients with minimal atherosclerotic disease. The success of endovascular techniques is also limited by the availability of skilled interventionalists, properly outfitted angiography suites, and suitable stent graft devices. Despite these challenges, the potential advantages of endovascular stenting make it a welcome addition to the armamentarium of the vascular interventionalist who treats arterial traumatic injuries.
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du Toit D, Coolen D, Lambrechts A, de V. Odendaal J, Warren B. The Endovascular Management of Penetrating Carotid Artery Injuries: Long-term Follow-up. Eur J Vasc Endovasc Surg 2009; 38:267-72. [DOI: 10.1016/j.ejvs.2009.05.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 05/08/2009] [Indexed: 11/28/2022]
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Abstract
A 48-year-old Caucasian male developed an iatrogenic arteriovenous fistula involving a branch of the circumflex iliac artery and an abdominal wall vein after undergoing paracentesis 3 months prior to his presentation. He presented to our emergency room with a large abdominal wall haematoma. The fistula that caused the haematoma was embolised with no further complication.
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Affiliation(s)
- Adam Saad
- Drexel University, Surgery, Broad and Vine Street, Philadelphia, Pennsylvania, 19102, USA
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Cohen JE, Rajz G, Gomori JM, Verstandig A, Berlatzky Y, Anner H, Grigoriadis S, Lylyk P, Ceratto R, Klimov A. Urgent endovascular stent-graft placement for traumatic penetrating subclavian artery injuries. J Neurol Sci 2008; 272:151-7. [PMID: 18649895 DOI: 10.1016/j.jns.2008.05.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 05/16/2008] [Accepted: 05/21/2008] [Indexed: 11/20/2022]
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41
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Burli P, Winterbottom AP, Cousins C, Appleton DS, See TC. Imaging appearances and endovascular management of uncommon pseudoaneurysms. Clin Radiol 2008; 63:1254-64. [PMID: 18929043 DOI: 10.1016/j.crad.2008.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 04/07/2008] [Accepted: 04/08/2008] [Indexed: 11/20/2022]
Abstract
Pseudoaneurysms are uncommon and their aetiology is varied. They occur in numerous anatomical locations and present with a multitude of clinical presentations sometimes life-threatening. This review describes the causes, sites, and presentations of uncommon pseudoaneurysms, as well as illustrating their diagnostic appearances and endovascular management.
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Rasmussen TE, Clouse WD, Peck MA, Bowser AN, Eliason JL, Cox MW, Woodward EB, Jones WT, Jenkins DH. Development and Implementation of Endovascular Capabilities in Wartime. ACTA ACUST UNITED AC 2008; 64:1169-76. [DOI: 10.1097/ta.0b013e31816b6564] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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43
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Karkos CD, Mair R, Markose G, Fishwick G, London NJM, Naylor AR. Hybrid procedures combining open and endovascular surgical techniques for the management of subclavian artery injuries. ACTA ACUST UNITED AC 2008; 63:E107-10. [PMID: 16983301 DOI: 10.1097/01.ta.0000223943.61967.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Christos D Karkos
- Department of Vascular and Endovascular Surgery, Leicester Royal Infirmary, Leicester, United Kingdom.
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Iezzi R, Cotroneo AR, Pascali D, Merlino B, Storto ML. Multi-slice CT (MSCT) angiography for assessment of traumatic lesions of lower limbs peripheral arteries. Emerg Radiol 2007; 14:389-94. [PMID: 17674063 DOI: 10.1007/s10140-007-0656-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Accepted: 07/06/2007] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to evaluate the feasibility and effectiveness of multi-slice computed tomography (MSCT) angiography for the assessment of traumatic lesions involving the arteries of the lower limbs. MATERIALS AND METHODS Forty-seven patients with suspected arterial post-traumatic lesions of lower limbs underwent MSCT angiography (4 x 2.5-mm collimation, 3-mm slice width). The standards of reference were: digital subtraction angiography (DSA; patients with inconclusive/doubtful or positive MSCT angiography indicating a need for intravascular treatment), surgical findings (patients with positive MSCT angiography indicating a need for surgery), or clinical/investigational follow-up (patients with negative MSCT angiography and no need for further diagnostic procedures or surgery). RESULTS All CT exams were technically adequate. Sensitivity, specificity, and overall diagnostic accuracy of MSCT angiography were 96.3, 90, and 93.6%, respectively, relative to the reference of standard findings. In 44 out of 47 patients, MSCT angiography allowed a correct continuation of the diagnostic work-up. CONCLUSION MSCT angiography is a reliable fast tool for diagnosing traumatic vascular lesions, providing results comparable to DSA.
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Affiliation(s)
- Roberto Iezzi
- Department of Radiology, University of Chieti, Osp. SS. Annunziata, Via dei Vestini, 66013, Chieti, Italy.
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Yi NJ, Suh KS, Lee HW, Cho EH, Shin WY, Cho JY, Lee KU. An artificial vascular graft is a useful interpositional material for drainage of the right anterior section in living donor liver transplantation. Liver Transpl 2007; 13:1159-67. [PMID: 17663413 DOI: 10.1002/lt.21213] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Congestion in the anterior section in a right liver (RL) without a middle hepatic vein (MHV) may lead to graft dysfunction. To solve this problem, an RL draining MHV branches with autologous or cryopreserved vessels can be introduced. However, these vessels are often unavailable, and their preparation is time-consuming. An expanded polytetrafluoroethylene (ePTFE) graft may be used for anterior section drainage. Between February and November 2005, 26 recipients underwent RL liver transplantation draining MHV branches with an ePTFE graft (group P). Twenty-six ePTFE grafts (6 or 7 mm in internal diameter) drained 35 MHV branches on the back table to the graft right hepatic vein or to the recipient's inferior vena cava. The patency of the ePTFE graft was checked with computed tomography scans of the liver. The outcome of group P was compared with those of an RL group with MHV (group M, n=17) and an RL group without reconstruction of MHV or its tributaries (group R, n=85). The 1-month and 4-month patency rates (PRs) of the ePTFE grafts were 80.8% (21/26) and 38.5% (10/26). All showing early obstruction of the ePTFE graft had congestion in the anterior section, but all showing late obstruction were asymptomatic. The 1-month PRs of group P were comparable to, but the 4-month PRs were lower than, those of group M (both 94.1%; P<0.05). However, 1-year patient and graft survival rates of group P (both 100%) were comparable to those of group M (94.1% and 100%) and better than those of group R (83.5% and 88.2%; P<0.05). In conclusion, the early PR of group P was good, and late obstruction of the ePTFE graft had no impact on congestion in the anterior section or patient survival. Therefore, an ePTFE graft may be a useful interposition material for anterior section drainage in RL transplantation without serious complications.
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Affiliation(s)
- Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Wheeler SC, Zinn KM, Hughes TW. Endovascular Covered Stent Repair of an Iatrogenic Subclavian Artery–to–Pulmonary Artery Fistula and Pseudoaneurysm. J Vasc Interv Radiol 2007; 18:775-9. [PMID: 17538141 DOI: 10.1016/j.jvir.2007.02.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
An iatrogenic fistula and consequent pseudoaneurysm developed between the right subclavian artery and right pulmonary artery as a result of misplacement of a hemodialysis access catheter. The patient, who was considered to be at high risk for surgical repair, successfully underwent endovascular treatment that involved insertion of two nitinol stents covered with expanded polytetrafluoroethylene (stent-grafts), one into the right subclavian artery and the other into a right upper lobe pulmonary artery. Multi-detector row computed tomographic angiography played an integral role in the evaluation of the patient's vascular injury and treatment planning.
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Affiliation(s)
- Shane C Wheeler
- Department of Interventional Radiology, Bridgeport Hospital/Yale New Haven Health, 267 Grant St, Bridgeport, CT 06610, USA.
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48
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Schoder M, Prokop M, Lammer J. Imaging and Intervention of Large Arterial Trauma. Emerg Radiol. [DOI: 10.1007/978-3-540-68908-9_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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49
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Abstract
Accidental insertion of an arterial sheath is an uncommon but potentially serious complication of jugular venous catheterization. When the subclavian artery is inadvertently cannulated, sheath removal can be complicated by significant hemorrhage due to its incompressible location. We report a case of inadvertent insertion of an 8 French sheath into the subclavian artery, which was successfully removed and the puncture site sealed with a collagen-based vascular closure device (Angio-Seal STS Plus). This averted an otherwise emergent open surgical procedure to remove the sheath and repair the subclavian artery in a high-risk patient.
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Affiliation(s)
- Sharad V Shetty
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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Koseoglu K, Cildag B, Sen S, Boga M, Parildar M. Endovascular Treatment of a Mycotic Subclavian Artery Aneurysm Using Stent-graft. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.ejvsextra.2006.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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