An analysis of 50 surgically managed penetrating subclavian artery injuries

Abstract

Objectives: The surgical management and outcome of penetrating subclavian artery (SCA) injuries is presented in this article.

Design: A retrospective chart review is used to detail the management and outcome of penetrating SCA injuries.

Patients and methods: Patients with penetrating SCA injuries presenting to the Groote Schuur Hospital from January 1997 to December 2007 were reviewed. Demographic data, mechanism of injury, associated injuries, angiographic findings, surgical treatment, hospital stay, complications and mortality were noted.

Results: Fifty patients with penetrating SCA injuries were identified from an operating trauma database. Stab and gunshot wounds accounted for 40 and 10 SCA injuries, respectively. The mean Revised Trauma Score (RTS) was 7.2. Angiography was obtained in 37 patients; false aneurysm (13) and total occlusion (nine) were the two most common findings. A median sternotomy was required in 25 (50%) patients and emergency room thoracotomy was performed in two patients (4%) for initial haemorrhage control. Primary repair of SCA injuries was possible in 52% of the patients. Three SCA injuries (6%) were ligated and one patient received an endovascular stent. Morbidity was restricted to associated brachial plexus injuries. The limb salvage rate was 100% and there were no deaths.

Conclusion: Preoperative angiography was useful in planning an operative approach. Primary repair was possible in the majority of the patients and ligation of SCA injuries was life-saving in critically ill patients.