title: Associated venous injury significantly complicates presentation, management, and outcomes of axillosubclavian arterial trauma.
abstract: Axillosubclavian vessel injury (ASVI) is associated with high morbidity and mortality. Most studies are single-center experiences of small numbers of patients with penetrating injury. We assessed 21st-century presentation and management of ASVI and focused on outcomes of combined arterial/venous injury. We reviewed the National Trauma Data Bank for patients with isolated arterial ASVI (group 1) and combined arterial/venous ASVI (group 2). Demographics, injury severity parameters, interventions, complications, and outcomes were compared. We identified 581 patients with ASVI (mean age 35.1; 88.1% male), with 466 isolated arterial injuries and 115 combined arterial/venous injuries. Group 2 had lower presenting systolic blood pressure and Glasgow Coma Scale, and had higher rates of operative repair (55.7 vs. 43.1%, p = 0.016) and higher mortality (33.9 vs. 13.9%, p < 0.001). There were no differences in amputation (5.2 vs. 2.4%, p = 0.121), compartment syndrome (2.6 vs. 1.9%, p = 0.713), and deep vein thrombosis (0.9 vs. 0.2%, p = 0.357). When separated by mechanism of injury, combined injuries from blunt trauma did increase amputation rates (27.8 vs. 4.2%, p = 0.002). Multivariate analysis revealed that combined arterial/venous injury significantly increased risk of death (odds ratio [OR], 2.99; confidence interval [CI], 1.73 to 5.17; p = 0.0001). Penetrating injury had higher odds of death than blunt injury (OR, 1.96; CI, 1.03 to 3.73; p = 0.041). ASVI is rare but extremely lethal. Concomitant venous and arterial injury is not associated with worse limb-related outcomes, except in blunt injuries and resultant amputations, but is associated with a threefold increase in mortality rates compared with isolated arterial injury.
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston University Medical Center, Boston, Massachusetts.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kalish
authors.forename: Tony
authors.initials: T
authors.lastname: Nguyen
authors.forename: Naomi
authors.initials: N
authors.lastname: Hamburg
authors.forename: Robert
authors.initials: R
authors.lastname: Eberhardt
authors.forename: Denis
authors.initials: D
authors.lastname: Rybin
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Doros
authors.forename: Alik
authors.initials: A
authors.lastname: Farber
keywords: axillary trauma; subclavian trauma