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Journal of Trauma and Injury 2013;26(3):243-247.
Treatment of Subclavian Artery Injury in Multiple Trauma Patients by Using an Endovascular Approach: Two Cases
Jayun Cho, Heekyung Jung, Hyung Kee Kim, Kyoung Hoon Lim, Jinyoung Park, Seung Huh
1Trauma Center, Kyungpook National University Hospital, Daegu, Korea.
2Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea. shuh@knu.ac.kr
다발성 외상환자에서 혈관계 접근을 통해 치료한 쇄골하동맥 손상 2례
조자윤1,2, 정희경2, 김형기2, 임경훈1, 박진영1,2, 허 승2
1경북대학교병원 외상센
2경북대학교 의학전문대학원 외과학교실
Received: 31 July 2013   • Revised: 24 August 2013   • Accepted: 2 September 2013
Abstract
INTRODUCTION: Surgical treatment of subclavian artery (SA) injury is challenging because approaching the lesion directly and clamping the proximal artery is difficult. This can be overcome by using an endovascular technique. CASE 1: A 37-year-old male was drawn into the concrete mixer truck. He had a right SA injury with multiple traumatic injuries: an open fracture of the right leg with posterior tibial artery (PTA) injury, a right hemothorax, and fractures of the clavicle, scapula, ribs, cervical spine and nasal bone. The injury severity score (ISS) was 27. Computed tomography (CT) showed a 30-mm-length thrombotic occlusion in the right SA, which was 15 mm distal to the vertebral artery (VA). A self-expandable stent(8 mmx40 mm in size) was deployed through the right femoral artery while preserving VA flow, and the radial pulse was palpable after deployment. Other operations were performed sequentially. He had a viable right arm during a 13-month follow-up period. CASE 2: A 25-year-old male was admitted to our hospital due to a motorcycle accident. The ISS was 34 because of a hemothorax and open fractures of the mandible and the left hand. Intraoperative angiography was done through a right femoral artery puncture. Contrast extravasation of the SA was detected just outside the left rib cage. After balloon catheter had been inflated just proximal to the bleeding site, direct surgical exploration was performed through infraclavicular skin incision. The transected SA was identified, and an interposition graft was performed using a saphenous vein graft. Other operations were performed sequentially. He had a viable left arm during a 15-month follow-up period.
CONCLUSION
The challenge of repairing an SA injury can be overcome by using an endovascular approach.
Key Words: Subclavian artery; Vascular system injuries; Endovascular procedures
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