Management of axillo-subclavian arterial injuries and predictors of outcome.

AIM

Although incidence of subclavian and axillary artery injury account for less than 9% of all vascular injuries, trauma to these vessels presents a surgical challenge particularly with high mortality and morbidity rates. The aim of the study was to review our experience on subclavian and axillary vessels injury and to analyze factors that may influence results of reconstructive surgery.

METHODS

Data of 35 patients have been recorded between January 2000 and June 2010. Mean age was 24.86 ± 8.99 years and most were males (88.57%). Regression analysis was performed to find out factors affecting outcome. The mean follow-up time was 60 months. The artery was injured in 32 of the 35 cases (91.43%) and the vein was injured in nine cases (25.71%).

RESULTS

Seven of 24 reconstructions with saphenous graft failed as a result of thrombosis, whereas all of seven prosthetic grafts were patent during the long-term follow-up period. Except one, all surgical interventions followed by warfarin administration were patent while seven repair failures occurred among the anticoagulation-free interventions.

CONCLUSION

Autologous vein graft must be the first choice; however, in case of size discrepancy, prosthetic graft usage may be an alternative approach and postoperative administration of anticoagulants may be considered at least in the presence of certain risk factors such as native artery-graft diameter discrepancy, thrombus history and prosthetic graft.