Elkbuli Adel, Shaikh Saamia, McKenney Mark, Boneva Dessy
Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States.
Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States.
Int J Surg Case Rep. 2019;61:157-160. doi: 10.1016/j.ijscr.2019.07.061. Epub 2019 Jul 25.
Subclavian artery injuries are rare and are associated with a high morbidity and mortality. The majority of patients with blunt trauma to the subclavian artery succumb to their injury before reaching a hospital. In-hospital mortality remains high.
We report the case of a 30-year-old male who presented with complete traumatic subclavian artery avulsion after a motorcycle collision. He presented in hemorrhagic shock. Temporary hemostatic control was achieved with endovascular balloon occlusion followed by operative intervention.
Prompt diagnosis and meticulous management including early transfusion, when indicated, are necessary to salvage both the patient's life and limb from such severe injuries. Intra-operative diagnosis of subclavian artery injury is most common due to the hemodynamic instability of most patients with such injuries; however, conventional angiography and computed tomography angiography are useful diagnostic modalities as well. Temporizing measures such as endovascular balloon occlusion to obtain vascular control may serve as a valuable adjunct to surgical repair.
Repair of a subclavian artery injury is challenging for even the most experienced of surgeons. Endovascular techniques can be therapeutic or used as an adjunct to control bleeding ad allow an open repair.
锁骨下动脉损伤较为罕见，且与高发病率和死亡率相关。大多数锁骨下动脉钝性创伤患者在到达医院之前就因伤死亡。院内死亡率仍然很高。
我们报告一例30岁男性病例，该患者在摩托车碰撞后出现完全性创伤性锁骨下动脉撕脱伤。他就诊时处于失血性休克状态。通过血管内球囊闭塞实现了临时止血控制，随后进行了手术干预。
对于此类严重损伤，为挽救患者生命和肢体，迅速诊断和细致管理（包括在必要时早期输血）是必要的。由于大多数此类损伤患者存在血流动力学不稳定，术中诊断锁骨下动脉损伤最为常见；然而，传统血管造影和计算机断层扫描血管造影也是有用的诊断方法。诸如血管内球囊闭塞以获得血管控制等临时措施可作为手术修复的宝贵辅助手段。
即使是经验最丰富的外科医生，修复锁骨下动脉损伤也具有挑战性。血管内技术可用于治疗或作为控制出血的辅助手段，以允许进行开放修复。
