University of Maryland Medical System, R Adams Cowley Shock Trauma Center, United States Air Force Baltimore Center for the Sustainment of Trauma and Readiness Skills, United States:
Injury. 2012 Nov;43(11):1785-92. doi: 10.1016/j.injury.2012.08.028. Epub 2012 Aug 22.
The role of endovascular treatment for vascular trauma, including injury to the subclavian and axillary arteries, continues to evolve. Despite growing experience with the utilization of these techniques in the setting of artherosclerotic and aneurysmal disease, published reports in traumatic subclavian and axillary arterial injuries remain confined to sporadic case reports and case series.
We conducted a review of the medical literature from 1990 to 2012 using Pubmed and OVID Medline databases to search for all reports documenting the use of endovascular stenting for the treatment of subclavian or axillary artery injuries. Thirty-two published reports were identified. Individual manuscripts were analysed to abstract data regarding mechanism, location and type of injury, endovascular technique and endograft type utilized, follow-up, and radiographic and clinical outcomes.
The use of endovascular stenting for the treatment of subclavian (150) or axillary (10) artery injuries was adequately described for only 160 patients from 1996 to the present. Endovascular treatment was employed after penetrating injury (56.3%; 29 GSW; 61 SW), blunt trauma (21.3%), iatrogenic catheter-related injury (21.8%) and surgical injury (0.6%). Injuries treated included pseudoaneurysm (77), AV fistula (27), occlusion (16), transection (8), perforation (22), dissection (6), or other injuries otherwise not fully described (4). Initial endovascular stent placement was successful in 96.9% of patients. Radiographic and clinical follow-up periods ranging from hospital discharge to 70 months revealed a follow-up patency of 84.4%. No mortalities related to endovascular intervention were reported. New neurologic deficits after the use of endovascular modalities were reported in only one patient.
Endovascular treatment of traumatic subclavian and axillary artery injuries continues to evolve. Early results are promising, but experience with this modality and data on late follow-up remain limited. Additional multicenter prospective study and capture of data for these patients is warranted to further define the role of this treatment modality in the setting of trauma.
血管损伤的血管内治疗，包括锁骨下动脉和腋动脉损伤，其作用仍在不断发展。尽管在动脉粥样硬化和动脉瘤疾病的治疗中越来越多地使用这些技术，但外伤性锁骨下和腋动脉损伤的报道仍然局限于零星的病例报告和病例系列。
我们使用 Pubmed 和 OVID Medline 数据库对 1990 年至 2012 年的医学文献进行了回顾，以搜索所有记录血管内支架置入治疗锁骨下或腋动脉损伤的报告。确定了 32 篇已发表的报告。对个别手稿进行分析，以提取有关机制、损伤位置和类型、血管内技术和使用的血管内移植物类型、随访以及影像学和临床结果的数据。
仅从 1996 年至今，对 160 名患者充分描述了血管内支架置入治疗锁骨下（150 例）或腋动脉（10 例）损伤的情况。血管内治疗应用于穿透性损伤（56.3%；29 例枪伤；61 例刀伤）、钝性损伤（21.3%）、医源性导管相关损伤（21.8%）和手术损伤（0.6%）。治疗的损伤包括假性动脉瘤（77 例）、动静脉瘘（27 例）、闭塞（16 例）、横断（8 例）、穿孔（22 例）、夹层（6 例）或其他未充分描述的损伤（4 例）。96.9%的患者初始血管内支架置入成功。影像学和临床随访时间从出院到 70 个月，显示通畅率为 84.4%。没有与血管内干预相关的死亡报告。只有一名患者报告使用血管内方式后出现新的神经功能缺损。
血管内治疗外伤性锁骨下和腋动脉损伤仍在不断发展。早期结果令人鼓舞，但这种治疗方式的经验和晚期随访的数据仍然有限。需要进行更多的多中心前瞻性研究和对这些患者的数据收集，以进一步确定这种治疗方式在创伤中的作用。
