title: Endovascular Management of a Combined Subclavian and Vertebral Artery Injury in an Unstable Polytrauma Patient: Case Report and Literature Review.
abstract: While blunt trauma of the head and neck are a common pattern of injury, significant problems related to the prompt diagnosis and optimal management of traumatic artery injuries have been reported in the literature. While patients with major artery injuries might develop hemorrhagic shock very rapidly, patients with blunt cerebrovascular injuries (BCVI) can present asymptomatic, but complications like basilar territory infarction, cortical blindness and death may occur. We report the life- and limb-saving management in a 57-year-old hemodynamically unstable trauma patient. The individual developed hemorrhagic shock, and other major complications, including cortical blindness, related to a posterior circulation stroke. Full recovery was achieved by immediate endovascular prosthesis for subclavian artery (SA) rupture and stenting of a traumatic vertebral artery occlusion. Endovascular and alternative treatment options are discussed and the management of subsequent sequelae associated with aggressive anticoagulation in trauma patients is reviewed, including intracranial, abdominal and other sites of secondary hemorrhage.
authors.affiliation: Department of Orthopaedics and Trauma Surgery, RWTH Aachen University Medical Center, Aachen, Germany.
authors.forename: Christian David
authors.initials: CD
authors.lastname: Weber
authors.affiliation: Department of Orthopaedics and Trauma Surgery, RWTH Aachen University Medical Center, Aachen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kobbe
authors.affiliation: Department of Orthopaedics and Trauma Surgery, RWTH Aachen University Medical Center, Aachen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Herren
authors.affiliation: Diagnostic and Interventional Radiology, University Hospital, Philipps University of Marburg, Marburg, Germany.
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Mahnken
authors.affiliation: Department of Orthopaedics and Trauma Surgery, RWTH Aachen University Medical Center, Aachen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Hildebrand
authors.affiliation: Department of Orthopaedics and Trauma Surgery, RWTH Aachen University Medical Center, Aachen, Germany.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Pape
keywords: Artery repair/stenting; Blunt cerebrovascular injury (BCVI); Subclavian Artery; Vascular injuries; Vertebral Artery