Blunt injury to the subclavian or axillary artery

Abstract

Background: This study is an analysis of our experience with blunt injuries to the subclavian or axillary artery in order to delineate the immediate challenges encountered and to assess immediate and long-term outcome.

Study design: A retrospective analysis was performed of 15 consecutive patients treated for a blunt injury to the subclavian or axillary artery in our hospital between 1988 and 1992.

Results: Ten patients had multiple injuries, and six were in a state of shock at admission. Bleeding from the artery contributed significantly to shock in three patients. Ischemia of the upper extremity was overt in ten patients. Two patients died as a result of associated injuries. Two patients with extensive tissue destruction underwent immediate amputation, one at shoulder level and one at middle arm. Five patients survived with a denervated limb from brachial plexus damage; in only one was the neurologic injury consistent with a potentially reversible lesion. Arterial repair, performed upon patients not undergoing amputation, was patent at a median time of 33 months in all but one patient. Among the seven patients with extensive disability (two amputated and five denervated extremities), only one patient resumed previous work.

Conclusions: Blunt trauma to a subclavian or axillary artery is associated with significant immediate morbidity and mortality. In the long-term, associated brachial plexus lesions plague most patients, who are left with a severe disability of the upper limb, which complicates their return to society.