Damage control for subclavian artery injury

Mortality from penetrating traumas involving the subclavian vessels can be as high as 60% in pre-hospital settings. Operating room mortality is in the range of 5-30%. This paper presents a case in which a strategy for damage control was employed for a patient with an injury to the origin of the left subclavian artery, using subclavian ligation, with no need for any other intervention, and maintaining viability of the left upper limb via collateral circulation. The authors also review surgical approaches and treatment strategies with a focus on damage control in subclavian vessel injuries.

Keywords:
chest traumas; subclavian artery; subclavian steal syndrome; vascular system injuries

Authorship

Adenauer Marinho de Oliveira Góes Junior

Cirurgia Vascular, Hospital Metropolitano de Urgência e Emergência – HMUE, Ananindeua, PA, Brasil.Hospital Metropolitano de Urgência e EmergênciaBrasilAnanindeua, PA, BrasilCirurgia Vascular, Hospital Metropolitano de Urgência e Emergência – HMUE, Ananindeua, PA, Brasil.

Faculdade de Medicina, Universidade Federal do Pará – UFPA, Belém, PA, Brasil.Universidade Federal do ParáBrasilBelém, PA, BrasilFaculdade de Medicina, Universidade Federal do Pará – UFPA, Belém, PA, Brasil.

http://orcid.org/0000-0001-9345-9539

Mariana Pereira Maurity

Cirurgia Geral, Hospital Metropolitano de Urgência e Emergência – HMUE, Ananindeua, PA, Brasil.Hospital Metropolitano de Urgência e EmergênciaBrasilAnanindeua, PA, BrasilCirurgia Geral, Hospital Metropolitano de Urgência e Emergência – HMUE, Ananindeua, PA, Brasil.

http://orcid.org/0000-0001-9208-4552

Carlos Alberto Costa do Amaral

Curso de Medicina, Universidade Faculdade Metropolitana da Amazônia – UNIFAMAZ, Belém, PA, Brasil.Universidade Faculdade Metropolitana da AmazôniaBrasilBelém, PA, BrasilCurso de Medicina, Universidade Faculdade Metropolitana da Amazônia – UNIFAMAZ, Belém, PA, Brasil.

No conflicts of interest declared concerning the publication of this article.

Correspondence Adenauer Marinho de Oliveira Góes Junior Domingos Marreiros, 307, apt 802 CEP 66055-210 - Belém (PA) - Brasil E-mail: adenauerjunior@gmail.com

Author information: AMOGJ - Member of Departamento Científico de Trauma Vascular, Sociedade Brasileira de Angiologia e Cirurgia vascular (SBACV); vascular surgeon and staff of Programa de Residência em Cirurgia Geral, Hospital Metropolitano de Urgências e Emergências, Ananindeua, PA, Brazil; adjunct professor of Habilidades Cirúrgicas at Faculdade de Medicina, Universidade Federal do Pará; professor at Internato de Clínica Cirúrgica, Centro Universitário do Estado do Pará, Belém, PA, Brazil. MPM - General surgery resident, Hospital Metropolitano de Urgência e Emergência (HMUE). CACA - Full member of Colégio Brasileiro de Radiologia; professor at Centro Universitário Faculdade Metropolitana da Amazônia’s medical school (UNIFAMAZ).

Author contributions: Conception and design: AMOGJ Analysis and interpretation: AMOGJ, CACA Data collection: MPM Writing the article: MPM Critical revision of the article: AMOGJ Final approval of the article*: AMOGJ, MPM, CACA Statistical analysis: N/A. Overall responsibility: AMOGJ, MPM *All authors have read and approved of the final version of the article submitted to J Vasc Bras.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (3)

Thumbnail

Figure 1
Photographs taken 3 months after surgery, showing functional recovery of the left upper limb. The arrow indicates the site of the gunshot wound.

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Figure 2
Angiotomography conducted 3 months after surgery. The reconstructions in 1.A, 1.B, and 1.C, show: A: aorta; *left vertebral artery; arrows indicate the left subclavian artery ligated at the origin and the point at which it becomes opaque again.

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Figure 3
Approaches for treatment of thoracic vascular injuries. Longitudinal continuous line: median sternotomy, the broken and dotted straight lines indicate possible cervical or right supraclavicular extensions. Solid curved lines indicate left anterolateral thoracotomy incisions over the fifth or third intercostal spaces; the dotted lines on the left hemithorax illustrate extension to a longitudinal sternotomy and supraclavicular incision (open book); while the thicker line indicates extension to a bilateral thoracotomy with transverse sternotomy.

Figure 1 Photographs taken 3 months after surgery, showing functional recovery of the left upper limb. The arrow indicates the site of the gunshot wound.

Figure 2 Angiotomography conducted 3 months after surgery. The reconstructions in 1.A, 1.B, and 1.C, show: A: aorta; *left vertebral artery; arrows indicate the left subclavian artery ligated at the origin and the point at which it becomes opaque again.

Figure 3 Approaches for treatment of thoracic vascular injuries. Longitudinal continuous line: median sternotomy, the broken and dotted straight lines indicate possible cervical or right supraclavicular extensions. Solid curved lines indicate left anterolateral thoracotomy incisions over the fifth or third intercostal spaces; the dotted lines on the left hemithorax illustrate extension to a longitudinal sternotomy and supraclavicular incision (open book); while the thicker line indicates extension to a bilateral thoracotomy with transverse sternotomy.

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[1] No conflicts of interest declared concerning the publication of this article.