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. 2019:61:157-160.
doi: 10.1016/j.ijscr.2019.07.061. Epub 2019 Jul 25.

Subclavian artery avulsion following blunt trauma: A case report and literature review

Adel Elkbuli  1 , Saamia Shaikh  2 , Mark McKenney  2 , Dessy Boneva  2
Affiliations

Subclavian artery avulsion following blunt trauma: A case report and literature review

Adel Elkbuli et al. Int J Surg Case Rep. 2019.

Abstract

Introduction: Subclavian artery injuries are rare and are associated with a high morbidity and mortality. The majority of patients with blunt trauma to the subclavian artery succumb to their injury before reaching a hospital. In-hospital mortality remains high.

Presentation of case: We report the case of a 30-year-old male who presented with complete traumatic subclavian artery avulsion after a motorcycle collision. He presented in hemorrhagic shock. Temporary hemostatic control was achieved with endovascular balloon occlusion followed by operative intervention.

Discussion: Prompt diagnosis and meticulous management including early transfusion, when indicated, are necessary to salvage both the patient's life and limb from such severe injuries. Intra-operative diagnosis of subclavian artery injury is most common due to the hemodynamic instability of most patients with such injuries; however, conventional angiography and computed tomography angiography are useful diagnostic modalities as well. Temporizing measures such as endovascular balloon occlusion to obtain vascular control may serve as a valuable adjunct to surgical repair.

Conclusion: Repair of a subclavian artery injury is challenging for even the most experienced of surgeons. Endovascular techniques can be therapeutic or used as an adjunct to control bleeding ad allow an open repair.

Keywords: Avulsion; Endovascular balloon occlusion; Subclavian artery; Subclavian artery bypass; Trauma outcomes; Vascular surgery.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Right subclavian artery avulsion and extravasation localizing the precise location of complete transection of the right subclavian artery.
Fig. 2
Fig. 2
Local contrast extravasation as a result of complete transection of the right subclavian artery.
Fig. 3
Fig. 3
Endovascular balloon at the right proximal subclavian artery.
Fig. 4
Fig. 4
Balloon deployed at the proximal end of the right subclavian artery. Also depicted above is the right common carotid artery and the right internal mammary artery intact just proximal to the balloon.
Fig. 5
Fig. 5
Right common carotid artery to right axillary artery bypass using cadaver vein graft.
See this image and copyright information in PMC

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