Nonpenetrating subclavian artery injuries
G. B. Zelenock, A. Kazmers, L. M. Graham, E. E. Erlandson, J. L. Cronenwett, W. M. Whitehouse Jr, T. W. Wakefield, S. M. Lindenauer and J. C. Stanley
Nonpenetrating subclavian artery trauma, a potentially catastrophic injury,
has been recognized more frequently with the liberal use of angiography in
evaluating blunt cervicothoracic trauma. Six patients, five men and one
woman, recently underwent surgical treatment at the University of Michigan
Hospital for blunt injury of the subclavian artery. The diagnoses were
established by arteriography. Physical findings, chest roentgenograms, and
results of noninvasive vascular evaluation were found to be nonspecific or
unreliable. Operative treatment with resection of the injured arterial
segments and either primary anastomosis or bypass grafting resulted in
restoration of distal, upper extremity blood flow in all of the cases. One
patient died 20 days after trauma from a severe associated cerebral injury.
Among the five survivors, residual soft tissue and neurologic injury
compromised full recovery in three. Thus, only two of the six patients
survived without sequelae, a fact that underscores the seriousness of this
type of subclavian artery injury.
