Subclavian and innominate artery trauma: a recent experience with nine patients

This report summarizes a recent 24-month experience with 9 patients who were treated for injuries to the innominate or subclavian arteries at a large urban hospital. All patients were male, age range was 17 to 47 years, and mean age was 29 years. The mechanism of injury included major arterial avulsions sustained during cancer operations at the base of the neck (2), blunt injuries secondary to motor vehicle accidents (2), stab wounds (1), and gunshot wounds (4). The vessels injured included the right subclavian artery (2), the innominate artery (1), and the left subclavian artery (6). Associated major venous injuries were seen in 4 cases (44%) and major non-vascular injuries in 5 cases (55%). Arterial exposure involved a variety of incisions, including left thoracotomy, median sternotomy, clavicular resection, or a combination of these. Arterial continuity was restored in all cases using primary repair (2), autogenous saphenous vein graft (6), or prosthetic graft (1). Venous injuries were treated by ligation (2) or lateral venorraphy (2). One patient died unexpectedly on the tenth postoperative day for an overall mortality of 11 percent. Three of the 8 survivors sustained nonfatal complications (38%). All 8 survivors had patent arterial repairs at the time of hospital discharge, and 5 of 8 survivors were available for follow-up with intravenous digital subtraction angiography (DSA), revealing arterial repair patency in all.(ABSTRACT TRUNCATED AT 250 WORDS)