Abstract
Background: Subclavian and axillary vascular injuries are notorious for their mortality and their difficult surgical exposure. In the present study we analyze our experience with 79 patients and describe the techniques used for surgical access to these vessels. Study Design: Retrospective review of the medical records of all patients with penetrating injuries to the subdavian or axillary vessels who had been admitted to 2 Los Angeles trauma centers during a 4-year, 3-month period. Results: Seventy-nine patients were admitted during the study period January 1993 to March 1997 (58 gunshot injuries, 21 other penetrating injuries). The artery was injured in 59 patients and the vein in 40 (20 patients had both arterial and venous injuries). Eighteen patients (23%) were admitted with no signs of life or were in extremis and underwent an emergency room thoracotomy without any survivors. Fifty-eight patients underwent exploration in the operating room, 1 patient with an arteriovenous subclavian fistula was successfully managed with a radiologically placed endovascular stent, and 2 patients with minimal subclavian artery injuries were managed nonoperatively. Overall mortality was 34.2%. Excluding the ER thoracotomies the overall mortality was 14.8%. The mortality for isolated arterial injuries was 20.5%, for isolated venous injuries 50%, and for both vessels 45.0%. The mortality in venous injuries was significantly higher than in arterial injuries (p <0.05). The standard clavicular incision provided adequate exposure in 32 (50.0%) of the operating room cases. In the other 50% of operating room cases a combination of a clavicular incision with a median sternotomy or thoracotomy was necessary. Proximal subclavian injuries may be accessed through a clavicular incision combined with a median sternotomy irrespective of left or right site location. Conclusions: Subclavian and axillary vascular injuries remain lethal. A clavicular incision provides satisfactory surgical exposure in about half the patients. In patients with proximal injuries addition of a median sternotomy provides adequate surgical access in both right and left subdavian vessels.
| Original language | English |
|---|---|
| Pages (from-to) | 290-295 |
| Number of pages | 6 |
| Journal | Journal of the American College of Surgeons |
| Volume | 188 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 1999 |
| Externally published | Yes |
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All Science Journal Classification (ASJC) codes
- Surgery
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Penetrating injuries to the subclavian and axillary vessels. / Demetriades, Demetrios; Chahwan, Santiago; Gomez, Hugo; Peng, Rick; Velmahos, George; Murray, James; Asensio, Juan A.; Bongard, Frederick.
In: Journal of the American College of Surgeons, Vol. 188, No. 3, 03.1999, p. 290-295.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Penetrating injuries to the subclavian and axillary vessels
AU - Demetriades, Demetrios
AU - Chahwan, Santiago
AU - Gomez, Hugo
AU - Peng, Rick
AU - Velmahos, George
AU - Murray, James
AU - Asensio, Juan A.
AU - Bongard, Frederick
PY - 1999/3
Y1 - 1999/3
N2 - Background: Subclavian and axillary vascular injuries are notorious for their mortality and their difficult surgical exposure. In the present study we analyze our experience with 79 patients and describe the techniques used for surgical access to these vessels. Study Design: Retrospective review of the medical records of all patients with penetrating injuries to the subdavian or axillary vessels who had been admitted to 2 Los Angeles trauma centers during a 4-year, 3-month period. Results: Seventy-nine patients were admitted during the study period January 1993 to March 1997 (58 gunshot injuries, 21 other penetrating injuries). The artery was injured in 59 patients and the vein in 40 (20 patients had both arterial and venous injuries). Eighteen patients (23%) were admitted with no signs of life or were in extremis and underwent an emergency room thoracotomy without any survivors. Fifty-eight patients underwent exploration in the operating room, 1 patient with an arteriovenous subclavian fistula was successfully managed with a radiologically placed endovascular stent, and 2 patients with minimal subclavian artery injuries were managed nonoperatively. Overall mortality was 34.2%. Excluding the ER thoracotomies the overall mortality was 14.8%. The mortality for isolated arterial injuries was 20.5%, for isolated venous injuries 50%, and for both vessels 45.0%. The mortality in venous injuries was significantly higher than in arterial injuries (p <0.05). The standard clavicular incision provided adequate exposure in 32 (50.0%) of the operating room cases. In the other 50% of operating room cases a combination of a clavicular incision with a median sternotomy or thoracotomy was necessary. Proximal subclavian injuries may be accessed through a clavicular incision combined with a median sternotomy irrespective of left or right site location. Conclusions: Subclavian and axillary vascular injuries remain lethal. A clavicular incision provides satisfactory surgical exposure in about half the patients. In patients with proximal injuries addition of a median sternotomy provides adequate surgical access in both right and left subdavian vessels.
AB - Background: Subclavian and axillary vascular injuries are notorious for their mortality and their difficult surgical exposure. In the present study we analyze our experience with 79 patients and describe the techniques used for surgical access to these vessels. Study Design: Retrospective review of the medical records of all patients with penetrating injuries to the subdavian or axillary vessels who had been admitted to 2 Los Angeles trauma centers during a 4-year, 3-month period. Results: Seventy-nine patients were admitted during the study period January 1993 to March 1997 (58 gunshot injuries, 21 other penetrating injuries). The artery was injured in 59 patients and the vein in 40 (20 patients had both arterial and venous injuries). Eighteen patients (23%) were admitted with no signs of life or were in extremis and underwent an emergency room thoracotomy without any survivors. Fifty-eight patients underwent exploration in the operating room, 1 patient with an arteriovenous subclavian fistula was successfully managed with a radiologically placed endovascular stent, and 2 patients with minimal subclavian artery injuries were managed nonoperatively. Overall mortality was 34.2%. Excluding the ER thoracotomies the overall mortality was 14.8%. The mortality for isolated arterial injuries was 20.5%, for isolated venous injuries 50%, and for both vessels 45.0%. The mortality in venous injuries was significantly higher than in arterial injuries (p <0.05). The standard clavicular incision provided adequate exposure in 32 (50.0%) of the operating room cases. In the other 50% of operating room cases a combination of a clavicular incision with a median sternotomy or thoracotomy was necessary. Proximal subclavian injuries may be accessed through a clavicular incision combined with a median sternotomy irrespective of left or right site location. Conclusions: Subclavian and axillary vascular injuries remain lethal. A clavicular incision provides satisfactory surgical exposure in about half the patients. In patients with proximal injuries addition of a median sternotomy provides adequate surgical access in both right and left subdavian vessels.
UR - http://www.scopus.com/inward/record.url?scp=0032963562&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0032963562&partnerID=8YFLogxK
U2 - 10.1016/S1072-7515(98)00289-0
DO - 10.1016/S1072-7515(98)00289-0
M3 - Article
C2 - 10065818
AN - SCOPUS:0032963562
VL - 188
SP - 290
EP - 295
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
SN - 1072-7515
IS - 3
ER -