Aggressive management of vascular injuries of the thoracic outlet

C. E. Hyre, D. F. Cikrit, S. G. Lalka, Alan Sawchuk, Michael Dalsing, J. J. Schuler

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Purpose: We present a review of 35 patients who underwent an operation for subclavian (n = 18) or axillary (n = 17) vessel injury. In some patients, both an artery and a vein were damaged, resulting in a total of 30 arterial and 16 venous injuries. Methods: The wounding source included a gunshot (n = 19), a stab wound (n = 9,) and blunt trauma (n = 7). Seven patients had hypotension and were taken immediately to the operating room. Seventeen patients had diminished or absent pulses, whereas 13 patients had normal pulses despite an arterial injury. Associated injuries included nerve injury (n = 15), pneumohemothorax (n = 5), and fractures (n = 7). Angiography in 21 patients demonstrated an intimal flap (n = 8), extravasation (n = 5), a pseudoaneurysm (n = 3), an arteriovenous fistula (n = 2), and occlusion (n = 1). Two angiograms were normal. Arterial repair was accomplished by interposition graft (n = 17), primary repair (n = 9), patch angioplasty (n = 3,) and ligation (n = 1). Results: No functional deficits occurred in patients with an isolated vascular injury. Seven patients with associated brachial plexus injuries experienced severe disability. One arm of a patient was amputated. Two patients died. Conclusions: The use of angiography helps to confirm and localize injuries. Prompt correction of the vascular injury avoids disability resulting from ischemia. Although the amputation rate is low with vascular repair, the functional disability resulting from associated nerve injuries can be devastating.

Original languageEnglish (US)
Pages (from-to)880-885
Number of pages6
JournalJournal of Vascular Surgery
Volume27
Issue number5
StatePublished - 1998
Externally publishedYes

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Vascular System Injuries
Thorax
Wounds and Injuries
Angiography
Arm Injuries
Tunica Intima
Stab Wounds
Brachial Plexus
False Aneurysm
Arteriovenous Fistula
Operating Rooms
Amputation
Angioplasty
Hypotension
Ligation
Blood Vessels
Veins
Arm
Ischemia
Arteries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Hyre, C. E., Cikrit, D. F., Lalka, S. G., Sawchuk, A., Dalsing, M., & Schuler, J. J. (1998). Aggressive management of vascular injuries of the thoracic outlet. Journal of Vascular Surgery, 27(5), 880-885.

Aggressive management of vascular injuries of the thoracic outlet. / Hyre, C. E.; Cikrit, D. F.; Lalka, S. G.; Sawchuk, Alan; Dalsing, Michael; Schuler, J. J.

In: Journal of Vascular Surgery, Vol. 27, No. 5, 1998, p. 880-885.

Research output: Contribution to journalArticle

Hyre, CE, Cikrit, DF, Lalka, SG, Sawchuk, A, Dalsing, M & Schuler, JJ 1998, 'Aggressive management of vascular injuries of the thoracic outlet', Journal of Vascular Surgery, vol. 27, no. 5, pp. 880-885.
Hyre, C. E. ; Cikrit, D. F. ; Lalka, S. G. ; Sawchuk, Alan ; Dalsing, Michael ; Schuler, J. J. / Aggressive management of vascular injuries of the thoracic outlet. In: Journal of Vascular Surgery. 1998 ; Vol. 27, No. 5. pp. 880-885.
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