Aksoy Murat, Tunca Fatih, Yanar Hakan, Guloglu Recep, Ertekin Cemalettin, Kurtoglu Mehmet
Department of General Surgery, Istanbul Medical Faculty, Istanbul University, Turgut Ozal Cad., Capa 34310, Istanbul, Turkey.
Surg Today. 2005;35(7):561-5. doi: 10.1007/s00595-005-2990-y.
By reviewing our experience, we evaluated the presentation, management, and long-term outcome of patients with subclavian and axillary artery injuries resulting from trauma.
We retrospectively reviewed the data of 38 patients who received treatment for subclavian or axillary artery injuries in the Emergency and Trauma Department of Medical Faculty of Istanbul, Istanbul University between January 1989 and July 2002.
Arterial injuries were repaired with an end-to-end anastomosis in 10 (26.3%) patients, primary repair in 6 (15.7%), autologous vein graft interposition in 16 (42%), ligation in 5 (13.1%), and a proximal subclavian-brachial artery bypass in 1 (2.6%). One (2.6%) of the arterial reconstructions failed in the perioperative period. Fourteen (36%) patients presented with a neurological deficit, which recovered after the intervention in 2 (5.2%) patients. A wound infection developed in 8 (21%) patients and 2 (5.2%) patients died of concomitant injuries. Thirteen (36.1%) of the remaining 36 patients were followed up for a mean period of 7 months.
Successful management of subclavian and axillary artery injuries requires prompt diagnosis because the occult nature of these injuries necessitates a high index of suspicion. Although revascularization procedures are often successful, it is the associated neurological, orthopedic, and soft tissue injuries that affect the functional outcome of the limb.
通过回顾我们的经验,我们评估了因创伤导致的锁骨下动脉和腋动脉损伤患者的临床表现、治疗方法及长期预后。
我们回顾性分析了1989年1月至2002年7月期间在伊斯坦布尔大学医学院急诊与创伤科接受锁骨下动脉或腋动脉损伤治疗的38例患者的数据。
10例(26.3%)患者采用端端吻合修复动脉损伤,6例(15.7%)进行一期修复,16例(42%)采用自体静脉移植,5例(13.1%)结扎,1例(2.6%)采用近端锁骨下-肱动脉旁路移植术。1例(2.6%)动脉重建在围手术期失败。14例(36%)患者出现神经功能缺损,其中2例(5.2%)在干预后恢复。8例(21%)患者发生伤口感染,2例(5.2%)患者死于合并伤。其余36例患者中有13例(36.1%)接受了平均7个月的随访。
成功治疗锁骨下动脉和腋动脉损伤需要及时诊断,因为这些损伤隐匿性强,需要高度怀疑。尽管血管重建手术通常很成功,但影响肢体功能结局的是相关的神经、骨科和软组织损伤。