title: Through-and-through wire technique for endovascular damage control in traumatic proximal axillary artery transection.
abstract: Repair of blunt shoulder trauma with transection of the subclavian or proximal axillary artery poses a surgical challenge, especially in instable patients. Endovascular treatment for initial damage control in arterial transection has evolved as a promising technique to improve outcome, but technical success can be limited in cases of complete transection as the lesion cannot be passed by a guidewire. This report describes an endovascular approach using a through-and-through brachial-femoral wire to control complete traumatic transection of the proximal axillary artery in a hemodynamically unstable patient. Endovascular therapy is used as a bridging method for open surgical repair three days later under optimized conditions with an interdisciplinary team. The brachial-femoral guidewire technique helps to overcome limitations in endovascular therapy in patients with blunt traumatic transection of thoracic outlet arteries.
authors.affiliation: Department of Vascular Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany f.rohlffs@uke.de.
authors.forename: Fiona
authors.initials: F
authors.lastname: Rohlffs
authors.affiliation: Department of Vascular Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Axel Antonio
authors.initials: AA
authors.lastname: Larena-Avellaneda
authors.affiliation: Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jan Philipp
authors.initials: JP
authors.lastname: Petersen
authors.affiliation: Department of Vascular Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Eike Sebastian
authors.initials: ES
authors.lastname: Debus
authors.affiliation: Department of Vascular Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Tilo
authors.initials: T
authors.lastname: Kölbel
mesh_terms: D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods; D001366:Axillary Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D001916:Brachial Artery / Q000000981:diagnostic imaging; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006439:Hemodynamics; D006470:Hemorrhage / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006489:Hemostatic Techniques / Q000295:instrumentation; D006801:Humans; D008297:Male; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D062666:Vascular Access Devices; D057772:Vascular System Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult
keywords: Through-and-through wire; arterial transection; axillary artery; damage control; snare; stent graft