Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 10 , ISSUE 3 ( September-December, 2021 ) > List of Articles

CASE REPORT

Artery and Subclavia Vein Injury due to Blunt Trauma: A Case Report and Literature Review

Juliane Rocha Bertelli Cabral, Karina Cavalcante da Silva, Isabella Aurea Signorini, Danielle Gonçalves de Carvalho Pinheiro, Arthur Alencar Raposo Tenorio, Joao Victor Pinheiro Nunes, Ana Carolina Teixeira, Paloma Oliveira de Vasconcelos, Tercio Campos

Keywords : Blunt trauma, Subclavian artery, Vascular injury

Citation Information : Cabral JR, da Silva KC, Signorini IA, de Carvalho Pinheiro DG, Tenorio AA, Nunes JV, Teixeira AC, de Vasconcelos PO, Campos T. Artery and Subclavia Vein Injury due to Blunt Trauma: A Case Report and Literature Review. Panam J Trauma Crit Care Emerg Surg 2021; 10 (3):126-129.

DOI: 10.5005/jp-journals-10030-1350

License: CC BY-NC 4.0

Published Online: 31-12-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Objective: To report the case and the clinical-surgical evolution of a patient after blunt cervical-thoracic trauma that resulted in fracture of the clavicle, injury to the subclavian artery and vein and almost total avulsion of the brachial plexus, as well as perform a literature review. Background: Vascular injury to the subclavian artery and vein through blunt trauma is rare. In blunt trauma, you run into an accident of high enough energy to injure the various structures that protect these vessels. Detailed anamnesis and physical examination are essential for elucidating the case, and imaging exams are excellent adjuvants in the decision-making process in these cases. Case report: A 33-year-old woman, victim of a collision of a motorcycle and a light pole, is referred to a secondary health service, where she develops ischemia of the left upper limb, associated with a fractured clavicle and brachial plexus injury. Patient underwent vascular and orthopedic surgery, respectively. The patient evolved with good general condition, good left upper limb perfusion and lack of sensitivity and movement of the limb. Conclusion: The evaluation of the case and the studies surveyed showed the complexity of the condition, making an assertive diagnosis and early approach to vascular lesions of the subclavian vessels essential, in order to obtain satisfactory results. Clinical significance: The rarity associated with the high complexity of subclavian vessel injury, as well as its high mortality when not detected quickly and correctly, makes this case report relevant to the scientific community, since its exposure is related to the literature review allows sharing important knowledge about the subject.


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  1. Ribeiro Jr, MAF. Fundamentos em cirurgia do trauma. 1. ed. Rio de Janeiro: Roca; 2016.
  2. Silva SA. Emergência e urgência em cirurgia vascular: um guia prático. 1. ed. Barueri: Manole; 2018.
  3. Abib SCV, Perfeito JAJ. Guias de medicina ambulatorial e hospitalar da UNIFESP-EPM: trauma. 1. ed. Barueri: Manole; 2012.
  4. Coulier B, Mairy Y, Etienne PY, et al. Diagnostic Tardifd’ pseudo aneurysm traumatique de l'ar tère sous-claviere. J Belge Radiol 1996;79:26–28. ISBN: 978-2-294-73544-8.
  5. Lederman A, Paiva F, Saes HM, et al. Ferimentos da artéria subclávia. Estudo retrospectivo de 20 casos. J Vasc Br 2005;4(2):149–154. Disponivel em: https://www.jvascbras.org/article/5df132a70e8825407db5f736
  6. Rich N, Hobson R, Jarstfer B, et al. Subclavian artery trauma. J trauma 1973;13(6):485–496. DOI: 10.1097/00005373-197306000-00001
  7. Graham JM, Feliciano DV, Mattox KL, et al. Management of subclavian vascular injuries. J trauma 1980;20(7):537–544. DOI: 10.1097/00005373-198007000-00001
  8. Costa MC, Robbs JV. Nonpenetrating subclavian artery trauma. J Vasc Surg 1988;8(1):71–75. DOI: 10.1067/mva.1988.avs0080071
  9. Lin PH, Koffron AJ, Guske PJ, et al. Penetrating injuries of subclavian artery. Am J Surg 2003;185(6):580–584. DOI: 10.1016/s0002-9610(03)00070-9
  10. McKinley AG, Carrim AT, Robbs JV. Management of proximal axillary and subclavian artery injuries. Br J Surg 2000;87(1):79–85. DOI: 10.1046/j.1365-2168.2000.01303.x
  11. Demetriades D, Chahwan S, Gomez H, et al. Penetrating injuries to the subclavian and axiallary vessels. J Am Coll Surg 1999;188(3):290–295. DOI: 10.1016/s1072-7515(98)00289-0
  12. Enamorado-Enamorado J, Egea-Guerrero JJ, Revuelto-Rey J, et al. Left subclavian artery pseudoaneurysm after a traffic accident: a case report. Case Rep Crit Care 2011;2011:1–2.
  13. Katras T, Baltazar U, Rush DS, et al. Subclavianarterial injury associated with blunt trauma. Vasc Surg 2001;35(1):43–50. DOI: 10.1177/153857440103500108
  14. Lee WA, Matsumura JS, Mitchell RS, et al. Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the society for vascular surgery. J Vasc Surg 2011;53(1):187–192. DOI: 10.1016/j.jvs.2010.08.027
  15. Goés Júnior AMO, Maurity MP, Amaral CAC. Controle de danos para lesão de artéria subclávia. J Vasc Bras 2020;19:e20200007. DOI: 10.1590/1677–5449.200007.
  16. Elkbuli A, Kinslow K, Dowd B, et al. Subclavian artery injury secondary to blunt trauma successfully managed by median sternotomy with supraclavicular extension: a case report and literature review. Ann Med Surg 2020;54:16–21. DOI: 10.1016/j.amsu.2020.03.012
  17. Elkbuli A, Shaikh S, McKenney M, et al. Subclavian artery avulsion following blunt trauma: A case report and literature review. Int J Surg Case Rep 2019;61:157–160. DOI: 10.1016/j.ijscr.2019.07.061
  18. Carlos, SF, Góis CC, Machado GF, et al. Traumatismo penetrante dos vasos subclávios: revisão da literatura a propósito de um caso clínico. Revista Portuguesa de Cirurgia, [S.l.], n. 32, pp. 35–41, mar. 2015. ISSN 2183-1165.
  19. Costa-Val R, Campos-Christo SF, Abrantes WL, et al. Reflections about civilian cardiovascular trauma admitted to a level 1 trauma center: a prospective study from 1000 cases. Rev Col Bra Cir 2008;35(3): 65. DOI: 10.1590/S0100-69912008000300005
  20. Hoff SJ, Reilly MK, Merrill WH, et al. Analysis of blunt and penetrating injury of the innominate and subclavian arteries. Am Surg 1994;60(2):151–154. PMID: 8304648.
  21. du Toit DF, Coolen D, Lambrechts A, et al. The endovascular management of penetrating carotid artery injuries: long-term follow-up. Eur J Vasc Endovasc Surg 2009;38(3):267–272. DOI: 10.1016/j.ejvs.2009.05.003
  22. Sobnach S, Nicol AJ, Nathire H, et al. An analysis of 50 surgically managed penetrating subclavian artery injuries. Eur J Vasc Endovasc Surg 2010;39(2):155–159. DOI: 10.1016/j.ejvs.2009.10.013
  23. du Toit DF, Strauss DC, Blaszczyk M, et al. Endovascular treatment of penetrating thoracic outlet arterial injuries. Eur J Vasc Endovasc Surg 2000;19(5):489–495. DOI: 10.1053/ejvs.1999.1050
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