Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM.
Division of Vascular Surgery, University of New Mexico School of Medicine, Albuquerque, NM.
Ann Vasc Surg. 2023 Nov;97:392-398. doi: 10.1016/j.avsg.2023.05.013. Epub 2023 May 24.
Arterial axillosubclavian injuries (ASIs) are currently managed with open repair (OR) and endovascular stenting (ES). The long-term prognosis of patients with these and associated brachial plexus injuries is poorly understood. We hypothesize that OR and ES for ASI have similar long-term patency rates and that brachial plexus injuries would confer high long-term morbidity.
All patients at a level-1 trauma center who underwent procedures for ASI over a 12-year period (2010 to 2022) were identified. Long-term outcomes of patency rates, types of reintervention, rates of brachial plexus injury, and functional outcomes were then investigated.
Thirty-three patients underwent operations for ASI. OR was performed in 72.7% (n = 24) and ES in 27.3% (n = 9). ES patency was 85.7% (n = 6/7) and OR patency was 75% (n = 12/16), at a median follow-up of 20 and 5.5 months respectively. In subclavian artery injuries, ES patency was 100% (n = 4/4) and OR patency was 50% (n = 4/8) at a median follow-up of 24 and 12 months respectively. Long-term patency rates were similar between OR and ES (P = 1.0). Brachial plexus injuries occurred in 42.9% (n = 12/28) of patients. Ninety percent (n = 9/10) of patients with brachial plexus injuries who were followed postdischarge had persistent motor deficits at median follow-up of 12 months, occurring at significantly higher rates in patients with brachial plexus injuries (90%) compared to those without brachial plexus injuries (14.3%) (P = 0.0005).
Multiyear follow-up demonstrates similar OR and ES patency rates for ASI. Subclavian ES patency was excellent (100%) and prosthetic subclavian bypass patency was poor (25%). brachial plexus injuries were common (42.9%) and devastating, with a significant portion of patients having persistent limb motor deficits (45.8%) on long-term follow-up. Algorithms to optimize brachial plexus injuries management for patients with ASI are high-yield, and likely to influence long-term outcomes more than the technique of initial revascularization.
目前，腋动脉锁骨下动脉损伤（ASIs）的治疗方法是开放修复（OR）和血管内支架置入术（ES）。这些损伤和相关臂丛神经损伤患者的长期预后尚不清楚。我们假设 OR 和 ES 治疗 ASI 的长期通畅率相似，而臂丛神经损伤则会导致高长期发病率。
在 12 年期间（2010 年至 2022 年），在一家一级创伤中心对所有接受 ASI 治疗的患者进行了手术。然后，研究了通畅率、再干预类型、臂丛神经损伤发生率和功能结局的长期结果。
33 例患者接受了 ASI 手术。72.7%（n=24）行 OR，27.3%（n=9）行 ES。ES 的通畅率为 85.7%（n=6/7），OR 的通畅率为 75%（n=12/16），中位随访时间分别为 20 个月和 5.5 个月。锁骨下动脉损伤患者中，ES 的通畅率为 100%（n=4/4），OR 的通畅率为 50%（n=4/8），中位随访时间分别为 24 个月和 12 个月。OR 和 ES 的长期通畅率相似（P=1.0）。42.9%（n=28）的患者发生臂丛神经损伤。90%（n=9/10）出院后随访的臂丛神经损伤患者在 12 个月的中位随访时仍存在运动功能障碍，臂丛神经损伤患者的发生率明显高于无臂丛神经损伤患者（90%比 14.3%）（P=0.0005）。
多年随访显示 ASI 的 OR 和 ES 通畅率相似。锁骨下动脉 ES 通畅率极好（100%），而人工锁骨下旁路通畅率较差（25%）。臂丛神经损伤很常见（42.9%），且具有破坏性，相当一部分患者在长期随访中仍存在肢体运动功能障碍（45.8%）。优化 ASI 患者臂丛神经损伤管理的算法是高收益的，可能比初次血运重建技术更能影响长期结果。
