Does endovascular repair of post-traumatic thoracic vascular injury of the subclavian/axillary arteries followed by brachial plexus injury improve outcome?

Abstract

Traumatic injuries to the axillary artery or subclavian artery along with a brachial plexus injury are infrequent. Although the traditional management has been conservative because of robust collaterals, the functional improvement of the limb depends on the degree of brachial plexus injury and on the revascularization status. We report three cases of endovascular repair post-traumatic axillo-subclavian artery injuries followed by brachial plexus injury with good functional outcomes. Endovascular repair of post-traumatic subclavian and axillary artery injuries followed by brachial plexus injury is safe and feasible, and improves limb outcomes.

Keywords: Axillo-subclavian artery injury; Brachial plexus injury; Endovascular repair; Trauma.

Fig. 1

a MRA showing occlusion of the first part of the axillary artery with distal reformation through collaterals at the third part of the axillary artery. b Diagnostic angiogram. c Right subclavian artery recanalization and stenting with balloon-expandable covered stent 6 × 38 mm (Advanta V12™, Getinge)

Fig. 2

a CTA showing 4-cm occlusion at the first part of the left subclavian and reformation through collaterals at the third part of the subclavian artery. b Diagnostic angiogram. c Recanalization/percutaneous transluminal angioplasty with a 7 mm × 40 mm non-compliant (Mustang, Boston Scientific) balloon and stenting of the left axillary artery with a self-expandable 6 mm × 80 mm bare-metal stent (Life stent™, Bard)

Fig. 3

a CTA showing 3.5-cm stenosis in the second part of the subclavian artery. b Diagnostic angiogram. c Left subclavian artery recanalization and stenting with balloon-expandable 6 × 55 mm bare-metal stent (Scuba™, Invatec)