Endovascular Treatment of Traumatic Injuries of the Subclavian, Carotid and Axillary Arteries
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- Category: Vol. 83, September 2015
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Endovascular Treatment of Traumatic Injuries of the Subclavian, Carotid and Axillary Arteries, AHMED G. KARMOTA, HUSSEIN O. ELWAN, AHMED A. TAHA, HUSSEIN M. KHAIRY and HUSSEIN K. HUSSEIN
Abstract
Objective: Injury to the subclavian, carotid or axillary arteries is uncommon. Exposure of these vessels is associated with significant morbidity, and mortality ranges from 5% to 30%. Endovascular methods may offer an alternative approach to these technically challenging injuries.
Methods: From March 2011 and February 2013, eight consecutive patients with traumatic subclavian, carotid and axillary artery injuries were treated endoluminally with covered stent. Treated vessels were subclavian (n=7), carotid (n=1) and axillary (n=1) and as one patient had carotid subclavian communication. The target lesion was accessed antegrade via the femoral artery (n=5), retrograde through the brachial artery (n=1), combined antegrade and retrograde via femoral and brachial artery (n1) amd triple access via both femoral and brachial access (n=1).
Results: Mean age was 34.5 years with 7 male and 1 female and all patients were symptomatic with palpable mass (n=5), palpable thrill (n=3) and rest pain (n=1). We had 7 cases of traumatic pseudoaneurysm and 1 cases of traumatic subclavian contusion; history of trauma was present in 8 cases with bullet injury 5/8 cases (62.5%), RTA 2/8 cases (25%) and one case of iatrogenic injury (12.5%). Ballon mounted covered stent were used to exclude arterial injury with two cases of endoleak managed successfully. Techniqal success occurred in 100%. Follow-up was up to 1 year in all patients with 30 day and 1 year survival rate were 100% and 1ry patency rate was 100% with no endoleak.
Conclusion: Covered stents are a feasible alternative to open repair in properly selected patients with subclavian, carotid or axillary artery injury, resulting in shorter procedure time and less blood loss.