Management of subclavian vascular injuries

Greater civilian use of firearms and improved transportation and resuscitation of the injured have provided our institutions with an increasing experience with subclavian vascular injuries. Ninety-three patients with subclavian vascular injuries are presented and two time periods are compared. Principles of management gained from the earlier experience have been utilized with a decline in mortality to 4.7% among the patients admitted with a palpable pulse or blood pressure. Successful treatment as before still lies in the recognition of the severity of the injury, rapidity of preparation for operation, and adequacy of surgical exposure. Recent trends have included an increased reliance on selective arteriography when the patient is stable, extensive use of the 'book' thoracotomy as a primary incision, preoperative and intraoperative autotransfusion, and a more frequent use of interposition grafting for vascular repair. Primary arterial repair was seldom accomplished; most patients required segmental resection with end-to-end anstomosis or interposition grafts.