Aggressive management of vascular injuries of the thoracic outlet.
OBJECTIVE
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.
Hyre
C E
CE
Department of Surgery, Indiana University Medical Center, Indianapolis, USA.
Cikrit
D F
DF
Lalka
S G
SG
Sawchuk
A P
AP
Dalsing
M C
MC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D017541:Aneurysm, False / Q000209:etiology; D000792:Angiography; D017130:Angioplasty; D001132:Arm / Q000601:surgery; D001164:Arteriovenous Fistula / Q000209:etiology; D001366:Axillary Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D001367:Axillary Vein / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D001917:Brachial Plexus / Q000293:injuries; D003251:Constriction, Pathologic / Q000209:etiology; D005260:Female; D050723:Fractures, Bone / Q000209:etiology; D006468:Hemopneumothorax / Q000209:etiology; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011674:Pulse; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D013350:Subclavian Vein / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D015996:Survival Rate; D013898:Thoracic Injuries / Q000601:surgery*; D017539:Tunica Intima / Q000293:injuries; D014948:Wounds, Gunshot / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000601:surgery; D014951:Wounds, Stab / Q000601:surgery