Skip to main content
SpringerLink
Log in

Subclavian Vessel Injuries: An Anatomic and Surgical Challenge to the Surgeon

  • Chapter
  • First Online:
The High-risk Surgical Patient

  • 1394 Accesses

Abstract

Subclavian vessel injuries represent complex challenges for Trauma Surgeons. These injuries are uncommon and highly lethal. Regardless of the mechanism of injury, they can result in significant morbidity and high mortality. Subclavian vessel injuries are generally associated with multiple life-threatening injuries. Injuries to these vessels pose great challenges to Trauma Surgeons, most of whom have very limited experience in these injuries. In addition, surgical exposure to these vessels, especially in the presence of active bleeding, can be extremely difficult and may challenge the skills of any experienced surgeon. Over the years, the overall mortality has continued to improve due to significant advancements in resuscitation, emergency medical transport systems, and the increased development of regionalized systems for the delivery of Trauma Care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Demetriades D, Asensio JA. Subclavian and axillary vascular injuries. Surg Clin North Am. 2001;81(6):1357–73. xiii

    CAS  PubMed  Google Scholar 

  2. Demetriades D, Asensio JA, Velmahos G, Thal E. Complex problems in penetrating neck trauma. Surg Clin North Am. 1996;76:665–83.

    Google Scholar 

  3. Demetriades D, Chahwan S, Gomez H, Peng R, Velmahos G, Murray J, Asensio J, Bongard F. Penetrating injuries to the subclavian and axillary vessels. J Am Coll Surg. 1999;188:290–5.

    CAS  PubMed  Google Scholar 

  4. Halted WS. Ligation of the first portion of the left subclavian artery and excision of a subclavio-axillary aneurysm. John Hopkins Hosp Bull. 1892;24:93.

    Google Scholar 

  5. Makins G. Gunshot injuries to the blood vessels. Bristol: John Wright and Sons; 1919.

    Google Scholar 

  6. Debakey ME, Simone FA. Battle injuries of arteries in World War II. An analysis of 2471 cases. Ann Surg. 1946;123:534–79.

    PubMed  PubMed Central  Google Scholar 

  7. Hughes CW. Arterial repair during the Korean War. Ann Surg. 1958;147:555–67.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Rich NM, Hobson RW, Jarstfer BS, Geer TM. Subclavian artery trauma. J Trauma. 1973;13:485–96.

    CAS  PubMed  Google Scholar 

  9. Rich NM, Baugh JH, Hughes CW. Acute arterial injuries in Vietnam: 1000 cases. J Trauma. 1970;10:359–69.

    CAS  PubMed  Google Scholar 

  10. Rich NM, Spencer FC. Subclavian artery injuries. In: Vascular trauma. Philadelphia: W.B. Saunders; 1978. p. 307–329.

    Google Scholar 

  11. White JM, Stannard A, Burkhardt G, Eastridge BJ, Blackbourne LH, Rasmussen TE. The epidemiology of vascular injury in the wars in Iraq and Afghanistan. Ann Surg. 2011;253(6):1184–9.

    PubMed  Google Scholar 

  12. Clouse WD, Rasmussen TE, Peck MA, et al. In theater management of vascular injury: 2 years of the Balad vascular registry. J Am Coll Surg. 2007;204:625–32.

    PubMed  Google Scholar 

  13. Graham JM, Feliciano DV, Mattox KL, Beall AC Jr, Debakey ME. Management of subclavian vascular injuries. J Trauma. 1980;20:537–44.

    CAS  PubMed  Google Scholar 

  14. George SM, Croce MA, Fabian TC. Cervithoracic arterial injuries: recommendations for diagnosis and management. World J Surg. 1991;15:134–40.

    PubMed  Google Scholar 

  15. Lim L, Saletta J, Flanigan D. Subclavian and innominate artery trauma. Surgery. 1979;86:890–7.

    CAS  PubMed  Google Scholar 

  16. McKinley AG, Carrim AT, Robbs JV. Management of proximal axillary and subclavian artery injuries. Br J Surg. 2000;87(1):79–85.

    CAS  PubMed  Google Scholar 

  17. McCready RA, Proctor CD, Hyde GL. Subclavian–axillary vascular trauma. J Vasc Surg. 1986;3:24–31.

    CAS  PubMed  Google Scholar 

  18. Wall MJ, Granchi T, Liscum K, Mattox KL. Penetrating thoracic vascular injuries. Surg Clin North Am. 1996;76:749–61.

    PubMed  Google Scholar 

  19. Demetriades D, Rabinoritz B, Pezikis A, Franklin J, Palexas G. Subclavian vascular injuries. Br J Surg. 1987;74:1001–3.

    CAS  PubMed  Google Scholar 

  20. Fletcher JP, Little JM. Injuries of branches of the aortic arch. Aust NZ J Surg. 1988;58:217–9.

    CAS  Google Scholar 

  21. Pate JW, Cole FH, Walker WA, Fabian TC. Penetrating injuries of the aortic arch and its branches. Ann Thorac Surg. 1993;55:586–92.

    CAS  PubMed  Google Scholar 

  22. Lin P, Koffron AJ, et al. Penetrating injuries of the subclavian artery. Am J Surg. 2003;185:580–4.

    PubMed  Google Scholar 

  23. Natali J, Maraval M, Kieffer E, Petrovic P. Fractures of the clavicle and injuries of the subclavian artery. J Cardiovasc Surg. 1975;16:541–7.

    CAS  Google Scholar 

  24. Richardson JD, McElvein RB, Trinkle JK. First rib fracture: a hallmark of severe trauma. Ann Surg. 1975;181:251–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Phillips EH, Rogers WF, Gaspar MR. First rib fractures: incidence of vascular injury and indications for angiography. Surgery. 1981;89:42–7.

    CAS  PubMed  Google Scholar 

  26. Gilroy D, Lakhoo M, Charalambides D, Demetriades D. Control of life-threatening, hemorrhage from the neck. A new indication for balloon tamponade. Injury. 1992;23:557–9.

    CAS  PubMed  Google Scholar 

  27. Hoff SJ, Reilly MK, Merrill WH, et al. Analysis of blunt and penetrating injury of the innominate and subclavian arteries. Am Surg. 1994;60:151–4.

    CAS  PubMed  Google Scholar 

  28. Abouljoud MS, Obeid FN, Horst HM, et al. Arterial injuries of the thoracic outlet: a ten-year experience. Am Surg. 1993;59:590–5.

    CAS  PubMed  Google Scholar 

  29. Graham JM, Feliciano DV, Mattox KL. Combine brachial, axillary and subclavian artery injuries of the same extremity. J Trauma. 1980;20(10):899–901.

    CAS  PubMed  Google Scholar 

  30. Cheema M, Kirton O, Lukose B, Gallagher J. Ligation of the subclavian artery after blunt trauma presenting as massive hemothorax. J Trauma. 2008;64:1126–30.

    PubMed  Google Scholar 

  31. Flint LM, Snyder WH, Perry MO, Shires GT. Management of major vascular injuries of the base of the neck. An 11-year experience with 146 cases. Arch Surg. 1973;106:407–13.

    CAS  PubMed  Google Scholar 

  32. Costa MC, Robbs JV. Nonpenetrating subclavian artery trauma. J Vasc Surg. 1988;8:71–5.

    CAS  PubMed  Google Scholar 

  33. Agarwal N, Shah P, Clauss RH, Reynolds BM, Steal WM. Experience with 115 civilian venous injuries. J Trauma. 1982;22:827–32.

    CAS  PubMed  Google Scholar 

  34. Gray H, Pick T, Holmes T. Anatomy, descriptive and surgical. Philadelphia: Henry C. Lea’s Son & Co.; 1883.

    Google Scholar 

  35. Demetriades D. Balloon tamponade for bleeding control from penetrating liver injuries. J Trauma. 1998;44:538–9.

    CAS  PubMed  Google Scholar 

  36. Katras T, Baltazar U, Rush DS, Davis D, Bell TD, Browder IW, Compton RP, Stanton PE. Subclavian arterial injury associated with blunt trauma. Vasc Surg. 2001;35(1):43–50.

    CAS  PubMed  Google Scholar 

  37. Hawthorn IE, Rochester J, Beard JD. Treatment of combined brachial plexus and subclavian artery trauma. Injury. 1993;24(6):377–9.

    CAS  PubMed  Google Scholar 

  38. Kalakuntla V, Patel V, Tagoe A, Weaver W. Six-year experience with management of subclavian artery injuries. Am Surg. 2000;66(10):927–30.

    CAS  PubMed  Google Scholar 

  39. Johnson SF, Johnson SB, Strodel WE, et al. Brachial plexus injury: association with subclavian and axillary vascular trauma. J Trauma. 1991;31:1546–50.

    CAS  PubMed  Google Scholar 

  40. Buscaglia LC, Walsh JC, Wilson JD, Maolo NM. Surgical management of subclavian artery injury. Am J Surg. 1987;54(1):88–92.

    Google Scholar 

  41. Dutort DF, Strauss DC, Blaszczyk M, et al. Endovascular treatment of penetrating thoracic outlet arterial injuries. Eur J Vasc Endovasc Surg. 2000;19:489–95.

    Google Scholar 

  42. Shah DM, Leather RP, Corson JD. PTFE grafts in the rapid reconstruction of acute contaminated peripheral vascular injuries. Am J Surg. 1984;148:229–33.

    CAS  PubMed  Google Scholar 

  43. Feliciano DV, Mattox KL, Graham JM. Five-year experience with PTFE grafts in vascular wounds. J Trauma. 1985;25:71–82.

    CAS  PubMed  Google Scholar 

  44. Johnson SF, Johnson SB, Strodel WE, Barker DE, Kearney PA. Brachial plexus injury: association with subclavian and axillary vascular trauma. J Trauma. 1991;31(11):1546–50.

    CAS  PubMed  Google Scholar 

  45. Robbs JV, Carrim AA, Kadwa AM, Mars M. Traumatic arterovenous fistula: experience with 202 patients. Br J Surg. 1994;81:1296–9.

    CAS  PubMed  Google Scholar 

  46. Old W, Oswaks R. Clavicular excision in management of vascular trauma. Am Surg. 1984;50:286–9.

    PubMed  Google Scholar 

  47. Degiannis E, Velmahos G, Krawczykowski D, Levy RD, Souter I, Saadia R. Penetrating injuries of the subclavian vessels. Br J Surg. 1994;81:524–6.

    CAS  PubMed  Google Scholar 

  48. Lee L, Miller TT, Schultz E, et al. Scapulothoracic dissociation. Am J Orthop. 1998;27:699–702.

    CAS  PubMed  Google Scholar 

  49. Demetriades D, Rabinoritz B, Pezikis A, et al. Subclavian vascular injuries. Br J Surg. 1987;74:1001–3.

    CAS  PubMed  Google Scholar 

  50. Schaff HV, Brawley RK. Operative management of penetrating vascular injuries of the thoracic outlet. Surgery. 1977;82:182–91.

    CAS  PubMed  Google Scholar 

  51. Degiannis E, Lery R, Potoka T, Saadia R. Penetrating injuries of the axillary artery. Aust NZ J Surg. 1995;65:327–30.

    CAS  Google Scholar 

  52. Patel AV, Marin ML, Veith FJ, et al. Endovascular graft repair of penetrating subclavian artery injuries. J Endovasc Surg. 1996;3:382–8.

    CAS  PubMed  Google Scholar 

  53. Giardo E, Marston LA, Ligush J, et al. Endovascular repair of peripheral aneurysms, pseudoaneurysms, and fistulas. Ann Vasc Surg. 1997;11:256–63.

    Google Scholar 

  54. Collard JM, Lattere PF, Bocurer F, et al. Conservative treatment of postsurgical lymphatic leaks with somotostatin-14. Chest. 2000;117:902–5.

    CAS  PubMed  Google Scholar 

  55. Degiannis E, Levy RD, Potokar T, et al. Penetrating injuries of the axillary artery. Aust NZ J Surg. 1995;65:327–30.

    CAS  Google Scholar 

  56. Demetriades D. Penetrating injuries to the thoracic great vessels. J Card Surg. 1997;12:173–80.

    CAS  PubMed  Google Scholar 

  57. D’Othee B, Rousseau H, Otal P, et al. Noncovered stent placement in a blunt traumatic injury of the right subclavian artery. Cardiovasc Intervent Radiol. 1999;22:424–7.

    Google Scholar 

  58. Demetriades D, Rabinowitz B, Pezikis A, et al. Subclavian vascular injuries. Br J Surg. 1987;74:1001–3.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Trauma Surgery & Surgical Critical Care, Trauma Center & Trauma Program, Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA

    Juan A. Asensio

  2. Department of Translational Science, Creighton University School of Medicine, Omaha, NE, USA

    Juan A. Asensio

  3. Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Juan A. Asensio & Miguel A. Cubano

  4. Creighton University Medical Center, Omaha, NE, USA

    Juan A. Asensio

  5. Department of Surgery, Creighton University, Medical School, Bethesda, MD, USA

    John J. Kessler & Parinaz J. Dabestani

  6. United States Navy Medical Corp., Navy Medical Center, San Diego, CA, USA

    Miguel A. Cubano

Authors
  1. Juan A. Asensio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John J. Kessler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Parinaz J. Dabestani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Miguel A. Cubano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Juan A. Asensio .

Editor information

Editors and Affiliations

  1. Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Paolo Aseni

  2. Divisione di Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo, Pavia, Pavia, Italy

    Antonino Massimiliano Grande

  3. Div. of Emerg. Surg., Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland

    Ari Leppäniemi

  4. Department of Pathophysiology and Transplantation, General Surgery and Trauma Team, University of Milano, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Osvaldo Chiara

Ethics declarations

All authors declare no conflicts of interest.

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Asensio, J.A., Kessler, J.J., Dabestani, P.J., Cubano, M.A. (2023). Subclavian Vessel Injuries: An Anatomic and Surgical Challenge to the Surgeon. In: Aseni, P., Grande, A.M., Leppäniemi, A., Chiara, O. (eds) The High-risk Surgical Patient. Springer, Cham. https://doi.org/10.1007/978-3-031-17273-1_70

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-17273-1_70

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-17272-4

  • Online ISBN: 978-3-031-17273-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation