Six-year experience with management of subclavian artery injuries

Penetrating injuries of the subclavian artery are rare; however, the associated morbidity and mortality may be high. Retrospective data on 25 patients who sustained penetrating subclavian artery injuries are reported. Diagnosis of subclavian artery injuries was made clinically and was followed by expedient surgical exploration in 65.4 per cent of patients. Patients who were hemodynamically unstable at presentation (26.9%) underwent immediate operation. The remaining hemodynamically stable group of patients with hard signs indicative of vascular injury were also expediently taken to the operating room after initial evaluation and resuscitation. Angiographic evaluation was performed in 34.6 per cent of patients who were stable hemodynamically. Preoperative angiography localized the injury and helped in planning the optimal incision and approach to obtain vascular control. Vascular flow was reestablished in all patients operated except for three who underwent ligation of subclavian artery. Limb salvage rate was 100 per cent, and operative mortality was less than 5 per cent. Morbidity was related to hemodynamic stability at presentation and associated injuries. A low morbidity and mortality rate was achieved by aggressive initial resuscitation and early surgical intervention coupled with selective use of preoperative angiography in hemodynamically stable patients.