Factors affecting the outcome of axillosubclavian arterial injuries

ABSTRACT

Twenty cases of subclavian artery injury and 14 cases of proximal artery injury were included in this study. Penetrating trauma was responsible for 26 cases of axillosubclavian arterial injuries, whereas blunt trauma accounted for only 8 patients. Thirty patients were presented with absent distal upper extremity pulses, while only four patients with subclavian artery injury suffered from a supraclavicular swelling with palpable distal pulses. Angiography was done in 17 patients who were vitally stable. Patients with soft signs that were suspicious of vascular injury underwent duplex study prior to angiography to confirm the diagnosis and angiography was followed to locate the site of the injury and to plan the operation. Four patients died before surgery and another four patients died intraoperatively from massive blood loss. Twenty patients needed saphenous interposition graft, four patients required venous patch, while the remaining two patients underwent a repair with synthetic graft [ringed PTFE, 8 mm] when suitably sized vein was not available and in the absence of contamination. The factors that influenced the mortality rate were the hemodynamic status of the patient, the presence of other associated injuries and the site of arterial injury. Preoperative ischemia time, the site of arterial injury and the presence of other associated injuries had a major impact as regards the postoperative morbidity. Associated brachial plexus injury is considered the most important item regarding postoperative morbidity, leaving the patient with very poor recovery of upper extremity function