Nonpenetrating subclavian artery trauma

Area of Science:

• Vascular Surgery
• Trauma Surgery
• Orthopedic Surgery

Background:

• Nonpenetrating injuries to the subclavian vessels are uncommon.
• This study reviews 167 patients with subclavian and superior mediastinal artery injuries over six years.

Purpose of the Study:

• To analyze the incidence, mechanisms, associated injuries, and outcomes of nonpenetrating subclavian artery injuries.
• To identify risk factors and propose preventative measures, particularly related to vehicle restraints.

Main Methods:

• Retrospective review of 167 patients with subclavian and superior mediastinal artery injuries.
• Analysis of injury patterns, associated injuries (rib fractures, brachial plexus disruption, clavicular fractures), and treatment outcomes.

Main Results:

• Fifteen injuries (9%) resulted from blunt trauma, with proximal artery involvement in 10 patients.
• Common associated injuries included rib fractures (n=11) and total brachial plexus disruption (n=9).
• Distal artery involvement correlated with clavicular fractures, absent radial pulse, and critical hand ischemia; outcomes included death, amputation, and functional deficits.

Conclusions:

• Nonpenetrating subclavian artery injuries are frequently associated with severe trauma and poor functional outcomes.
• Automobile accidents, particularly with improperly fitted seat belts, contribute significantly to these injuries.
• Correctly fitted restraining devices are crucial for preventing such severe vascular and neurological injuries.