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Subclavian vascular injuries
D Demetriades1, B Rabinowitz, A Pezikis
1Department of Surgery, University of the Witwatersrand Medical School, Johannesburg, South Africa.
Insights
Penetrating injuries to subclavian vessels have high mortality, especially venous injuries due to air embolism. Physical examination is sufficient for diagnosis, guiding a selective conservative treatment approach.
Area of Science:
- Vascular Surgery
- Trauma Care
- Emergency Medicine
Background:
- Penetrating trauma to the subclavian vessels presents a significant challenge in emergency medicine.
- High mortality rates are associated with injuries to these major thoracic vessels.
Purpose of the Study:
- To analyze the outcomes of penetrating injuries to the subclavian vein and artery.
- To evaluate diagnostic methods and treatment strategies for these injuries.
Main Methods:
- Retrospective analysis of 228 patients with penetrating subclavian vessel injuries.
- Review of injury patterns, diagnostic approaches, surgical interventions, and mortality rates.
Main Results:
- Overall mortality was 66%, with 61% of patients not surviving to hospital admission.
- Venous injuries had higher mortality (P < 0.01) than arterial injuries, likely due to air embolism.
- Physical examination was deemed reliable for diagnosis, negating the need for emergency angiography.
Conclusions:
- A selective conservative approach is recommended for subclavian vessel injuries.
- Prompt diagnosis via physical examination and appropriate surgical or non-surgical management are crucial for improving outcomes.
Abstract:
This study comprises 228 patients with penetrating injuries of the subclavian vessels. The vein alone was involved in 44 per cent, the artery alone in 39 per cent, and both vessels in 17 per cent. The majority of the victims (61 per cent) did not reach the hospital alive, and in those who were operated on the mortality was 15.5 per cent (overall mortality 66 per cent). The overall mortality of venous injuries was significantly higher than the arterial ones (P less than 0.01), probably because of the dangerous complication of air embolism. Physical examination is reliable in the diagnosis of these injuries and there is no need for an emergency angiogram. The clavicular incision was the preferred approach. Repair was performed in 94 per cent of those with arterial injury. Vein injuries were treated by suture in 60 per cent and ligation in 40 per cent. A selective conservative approach is advised.