Long-term intra-arterial shunt

Area of Science:

• Trauma Surgery
• Vascular Surgery
• Emergency Medicine

Background:

• Severe penetrating trauma to the axilla can lead to life-threatening hemorrhage.
• Axillary artery and vein injuries present complex management challenges in trauma patients.

Purpose of the Study:

• To report a case of successful management of a complex axillary artery and vein injury.
• To highlight the application of damage control principles and advanced reconstructive techniques in severe vascular trauma.

Main Methods:

• Initial resuscitation included endotracheal intubation, resuscitative thoracotomy with aortic cross-clamping, and massive fluid resuscitation.
• Damage control surgery involved ligation of the axillary vein and temporary intra-arterial shunting.
• Definitive repair utilized an extra-anatomic bypass with a reversed greater saphenous vein graft.

Main Results:

• The patient survived near-exsanguination and initial resuscitation.
• Postoperative complications included coagulopathy, adult respiratory distress syndrome (ARDS), and anuria, which largely resolved.
• Successful definitive vascular reconstruction resulted in an uneventful recovery and discharge.

Conclusions:

• Resuscitative thoracotomy and aortic cross-clamping can be life-saving even without thoracic injury.
• Damage control surgery, including temporary shunting and vein ligation, is a viable strategy for severe vascular injuries.
• Extra-anatomic vascular reconstruction is effective in contaminated fields for restoring limb perfusion.