ReviewEndovascular management of axillo-subclavian arterial injury: A review of published experience☆
Introduction
Traumatic injuries of the subclavian or axillary artery continue to be associated with high morbidity and mortality rates,1 requiring timely and effective management in the earliest phases after injury in order to optimize outcome. The management of these injuries has traditionally required operative surgical intervention. Open surgical approaches are, however, challenging due to the tightly confined arrangement of key neurovascular anatomical relationships of the apical thorax. This, combined with the dense overlying bony anatomy, precludes rapid surgical access to injured structures and confounds the ability to adequately control vascular structures for repair without causing injury to adjacent structures.
The emergence of endovascular modalities offers an alternative to traditional surgical management of select subclavian and axillary artery traumatic lesions. Since their introduction, endovascular technologies have seen expanded use for a variety of indications, including the treatment of these injuries. Published experience to date, however, remains limited. Reports of successful endovascular treatment of traumatic subclavian and axillary artery trauma remain confined to case reports and small series documented in the literature. Our study is designed to summarize the experience to date with endovascular treatment for these injuries through a review of the available medical literature.
Section snippets
Materials and methods
We conducted a systematic review of the English-speaking medical literature using Pubmed (www.pubmed.gov, accessed 1 Feb 2012) service of the National Library of Medicine/National Institutes of Health and the OVID Medline databases (Copyright © 2000–2011 Ovid Technologies) to identify all case reports and case series of subclavian and/or axillary artery endovascular management after injury to these vessels, either from trauma or iatrogenic injury. Specifically, the search terms “subclavian” or
Results
Forty-four published reports with endovascular treatment of subclavian or axillary artery injuries were identified. Twelve of these publications lacked sufficient information for inclusion and were excluded, leaving 32 published reports or case series available for review over the study time period of 1996–2012.2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33
The use of endovascular modalities after subclavian or axillary
Discussion
Injuries to the subclavian and axillary arteries continue to be associated with high rates of morbidity and mortality. In one of the landmark series on these injuries, Demetriades et al. at Los Angeles County + University of Southern California Hospital34 examined penetrating subclavian and axillary injuries, identifying 79 patients with these injuries over approximately 4 years. The associated overall mortality was 34.2%. Even after excluding those patients in extremis requiring resuscitative
Conclusion
Endovascular treatment of traumatic subclavian and axillary artery injuries continues to evolve. Despite uncertainties in patient selection and optimal management algorithms, early results are promising. Experience with this modality and data on late follow-up, however, remain limited. Additional multicenter prospective study and capture of data for these patients is warranted, in order to further define the role of this treatment modality in the setting of trauma.
Author contributions
All of the listed authors were actively engaged in study design, analysis and interpretation of data, as well as construction and editing of the final manuscript report for this work.
Conflict of interest statement
The authors have no conflicts of interest to disclose, financial or otherwise that are associated with this work.
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