Endovascular management of axillo-subclavian arterial injury: A review of published experience.
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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Background The role of endovascular treatment for vascular trauma, including injury to the subclavian and axillary arteries, continues to evolve. Despite growing experience with the utilization of these techniques in the setting of artherosclerotic and aneurysmal disease, published reports in traumatic subclavian and axillary arterial injuries remain confined to sporadic case reports and case series. Methods We conducted a review of the medical literature from 1990 to 2012 using Pubmed and OVID Medline databases to search for all reports documenting the use of endovascular stenting for the treatment of subclavian or axillary artery injuries. Thirty two published reports were identified. Individual manuscripts were analysed to abstract data regarding mechanism, location and type of injury, endovascular technique and endograft type utilized, follow up, and radiographic and clinical outcomes. Results The use of endovascular stenting for the treatment of subclavian 150 or axillary 10 artery injuries was adequately described for only 160 patients from 1996 to the present. Endovascular treatment was employed after penetrating injury 56.3 29 GSW 61 SW, blunt trauma 21.3, iatrogenic catheter related injury 21.8 and surgical injury 0.6. Injuries treated included pseudoaneurysm 77, AV fistula 27, occlusion 16, transection 8, perforation 22, dissection 6, or other injuries otherwise not fully described 4. Initial endovascular stent placement was successful in 96.9 of patients. Radiographic and clinical follow up periods ranging from hospital discharge to 70 months revealed a follow up patency of 84.4. No mortalities related to endovascular intervention were reported. New neurologic deficits after the use of endovascular modalities were reported in only one patient.
- Medicine and Medical Research