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Aggressive management of vascular injuries of the thoracic outlet.

Abstract：

PURPOSE:We present a review of 35 patients who underwent an operation for subclavian (n = 18) or axillary (n = 17) vessel injury. In some patients, both an artery and a vein were damaged, resulting in a total of 30 arterial and 16 venous injuries. METHODS:The wounding source included a gunshot (n = 19), a stab wound (n = 9,) and blunt trauma (n = 7). Seven patients had hypotension and were taken immediately to the operating room. Seventeen patients had diminished or absent pulses, whereas 13 patients had normal pulses despite an arterial injury. Associated injuries included nerve injury (n = 15), pneumohemothorax (n = 5), and fractures (n = 7). Angiography in 21 patients demonstrated an intimal flap (n = 8), extravasation (n = 5), a pseudoaneurysm (n = 3), an arteriovenous fistula (n = 2), and occlusion (n = 1). Two angiograms were normal. Arterial repair was accomplished by interposition graft (n = 17), primary repair (n = 9), patch angioplasty (n = 3,) and ligation (n = 1). RESULTS:No functional deficits occurred in patients with an isolated vascular injury. Seven patients with associated brachial plexus injuries experienced severe disability. One arm of a patient was amputated. Two patients died. CONCLUSIONS:The use of angiography helps to confirm and localize injuries. Prompt correction of the vascular injury avoids disability resulting from ischemia. Although the amputation rate is low with vascular repair, the functional disability resulting from associated nerve injuries can be devastating.

journal_name

J Vasc Surg

journal_title

Journal of vascular surgery

authors

Hyre CE,Cikrit DF,Lalka SG,Sawchuk AP,Dalsing MC

doi

10.1016/s0741-5214(98)70268-x

subject

Has Abstract

pub_date

1998-05-01 00:00:00

pages

880-4; discussion 884-5

issue

5

eissn

0741-5214

issn

1097-6809

pii

S0741521498001414

journal_volume

27

pub_type

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