St Mary's Hospital, London, UK.
George Washington University Hospital, Washington, DC, USA.
Ann R Coll Surg Engl. 2021 Sep;103(8):e244-e248. doi: 10.1308/rcsann.2020.7100.
Penetrating injuries to the subclavian artery carry a high mortality rate, especially when the patient presents in shock. Rapid and effective haemorrhage control is challenging due to the anatomical location at the thoracic outlet. Historically, vessel ligation has been used to control bleeding, but this is often performed late, when metabolic exhaustion is established, and is associated with upper-limb ischaemia and limb loss. Rapid proximal control through the chest with temporary intravascular shunting is the damage control technique of choice to temporise blood loss and restore perfusion until the patient is physiologically optimised for a delayed definitive vascular repair. We describe a case of vascular damage control in a patient after gunshot wound.
锁骨下动脉穿透性损伤的死亡率很高，尤其是当患者出现休克时。由于解剖位置在胸出口，快速有效的止血非常具有挑战性。历史上，血管结扎曾被用于控制出血，但通常在代谢衰竭已经建立时才进行，并且与上肢缺血和肢体丧失有关。通过胸腔进行快速近端控制并临时进行血管内分流是控制损伤的首选技术，可以暂时控制失血并恢复灌注，直到患者的生理状况适合延迟进行确定性血管修复。我们描述了一例枪伤后患者的血管损伤控制病例。
