Uncertain Patency of Covered Stents Placed for Traumatic Axillosubclavian Artery Injury

Traumatic axillosubclavian artery injuries (ASAIs) are uncommon but devastating. There is increasing acceptance of covered stent use for ASAIs. However, epidemiologic and long-term outcomes data are limited. We investigated national trends in ASAI management and our institutional outcomes after emergent covered stent placement and open surgical repairs for ASAIs.

A review of the National Trauma Data Bank from 2010 to 2012 was performed for epidemiologic data. International Classification of Diseases and procedure codes were used to identify ASAIs and therapy type. A single-center, retrospective review of consecutive patients with ASAIs between January 2010 and August 2014 was also performed.

National Trauma Data Bank review included 511,286 patients with 520 ASAIs, yielding an incidence of 0.1%. Endovascular therapy was used in 76 patients (14.7%) vs open repair in 280 patients (53.8%). Nonoperative or unknown treatment was used in 164 (31.5%). From 2010 to 2012, endovascular interventions increased from 11.3% to 17.2% (p < 0.05). Endovascular therapy was used more frequently in blunt compared with penetrating trauma (59.2% vs 40.8%; p < 0.005). Our institutional review identified 10 ASAIs treated with covered stents with a median follow-up of 117 days (interquartile range 13 to 447 days) and 70% lost to follow-up. No treatment-related mortality or amputation occurred. Stent occlusion occurred in 30% at a median of 132 days (interquartile range 30 to 223 days). Three patients with ASAIs were initially treated with open surgery, 2 died and the third required ligation.

Covered stents are being used increasingly for ASAIs nationwide, despite variable reports of durability. Follow-up is poor in urban trauma centers and might be responsible for the variable patency. Population-based efforts to improve compliance among trauma patients can help improve covered stent patency in ASAI.