Department of Vascular and Endovascular Surgery, Christchurch Hospital, Christchurch, New Zealand
Department of Orthopaedic Surgery, Christchurch Hospital, Christchurch, New Zealand.
BMJ Case Rep. 2021 Jul 2;14(7):e241382. doi: 10.1136/bcr-2020-241382.
Subclavian artery injury is a rare complication of clavicle fracture. The fractured clavicle can lacerate the underlying subclavian artery. Life-threatening haemorrhage can occur secondary to arterial laceration, and if distal blood flow is impaired, upper limb ischaemia can develop. There is little discussion in the literature regarding combined (or 'hybrid') endovascular and open surgical management of acute subclavian injuries secondary to clavicle fracture. We report a case of subclavian artery laceration secondary to clavicle fracture, managed with a combined endovascular and open surgical approach. An endovascular balloon was used for proximal arterial control, while surgical exposure and primary repair of the subclavian artery was completed, followed by fixation of the clavicle. There was no sustained vascular or neurological impairment at follow-up. We suggest that select traumatic injuries of the subclavian artery can be safely and successfully managed with a combined endovascular and open surgical approach.
锁骨下动脉损伤是锁骨骨折的罕见并发症。骨折的锁骨可撕裂下方的锁骨下动脉。动脉撕裂可导致危及生命的出血,如果远端血流受损,上肢可能会发生缺血。文献中很少讨论锁骨骨折继发急性锁骨下损伤的联合(或“混合”)血管内和开放手术治疗。我们报告了一例锁骨下动脉撕裂继发于锁骨骨折的病例,采用了血管内和开放手术相结合的方法进行治疗。使用血管内球囊进行近端动脉控制,同时完成锁骨下动脉的手术暴露和初步修复,然后固定锁骨。随访时无持续性血管或神经功能障碍。我们认为,一些特定的创伤性锁骨下动脉损伤可以通过血管内和开放手术相结合的方法安全有效地治疗。