Torres Inez Ohashi, Lourenço de Andrade Rebeca Cristina, Apoloni Rafael, Simão da Silva Erasmo, Puech-Leão Pedro, De Luccia Nelson
Vascular and Endovascular Surgery Department, São Paulo University Medical School, São Paulo, Brazil.
Vascular and Endovascular Surgery Department, São Paulo University Medical School, São Paulo, Brazil.
Eur J Vasc Endovasc Surg. 2023 Dec;66(6):840-847. doi: 10.1016/j.ejvs.2023.08.008. Epub 2023 Aug 9.
To evaluate the in hospital and long term outcomes after open or endovascular repair of subclavian and axillary artery injuries.
This was a retrospective, single centre study. Data were reviewed from patients with subclavian and or axillary injuries who presented to the authors' centre between January 2009 and December 2022. Outcome data included complications, death, amputations, and re-interventions. A p value < .050 was considered to be statistically significant.
Over the study period, 62 patients with subclavian or axillary trauma were admitted to the study hospital. Patients were young (median age 32.5 years, range 12 - 53) and most were men (85%); 32 patients experienced blunt trauma, and 30 penetrating trauma. The median injury severity score was 18 (interquartile range [IQR] 9, 34), and 47% of patients had a brachial plexus injury. The arterial injury was occlusion in 62% of patients, and the median ischaemia time was 12.5 hours (IQR 7.13, 24). All patients with subclavian injuries (n = 37) and 13 of 25 patients with an axillary injury underwent endovascular repair (stent graft placement). Open repair was performed in 12 patients with axillary injury (axillobrachial bypass in seven patients). At hospital discharge, the amputation free survival rate was 82% vs. 92% (p = .67), the mortality rate was 10% vs. 8% (p = 1.0), and the amputation rate was 10% vs. 0 (p = .57) for endovascular and open repair, respectively. The mean follow up time was 4.1 ± 3.5 years. After the seven year follow up, the stent primary patency was 42%. No re-interventions or amputations were performed after hospital discharge. Disability was related to fractures and soft tissue and brachial plexus injuries.
Endovascular treatment was preferred for patients with subclavian artery injuries. Open repair was preferred for patients with penetrating axillary injuries. In hospital and long term complications were related to fractures and soft tissue and brachial plexus injuries, rather than the treatment of arterial injuries. Measures are needed to reduce ischaemia time and improve brachial plexus injury repair.
评估锁骨下动脉和腋动脉损伤开放修复或血管腔内修复后的住院及长期预后。
这是一项回顾性单中心研究。回顾了2009年1月至2022年12月期间就诊于作者所在中心的锁骨下动脉和/或腋动脉损伤患者的数据。结局数据包括并发症、死亡、截肢和再次干预。p值<0.050被认为具有统计学意义。
在研究期间，62例锁骨下或腋动脉创伤患者入住研究医院。患者较为年轻（中位年龄32.5岁，范围12 - 53岁），大多数为男性（85%）；32例患者经历钝性创伤，30例为穿透性创伤。中位损伤严重程度评分为18（四分位间距[IQR]9, 34），47%的患者有臂丛神经损伤。62%的患者动脉损伤为闭塞，中位缺血时间为12.5小时（IQR 7.13, 24）。所有锁骨下动脉损伤患者（n = 37）和25例腋动脉损伤患者中的13例接受了血管腔内修复（支架植入）。12例腋动脉损伤患者接受了开放修复（7例患者行腋肱旁路术）。出院时，血管腔内修复和开放修复的无截肢生存率分别为82%对92%（p = 0.67），死亡率分别为10%对8%（p = 1.0），截肢率分别为10%对0（p = 0.57）。平均随访时间为4.1±3.5年。七年随访后，支架初始通畅率为42%。出院后未进行再次干预或截肢。残疾与骨折、软组织和臂丛神经损伤有关。
锁骨下动脉损伤患者首选血管腔内治疗。穿透性腋动脉损伤患者首选开放修复。住院及长期并发症与骨折、软组织和臂丛神经损伤有关，而非动脉损伤的治疗。需要采取措施减少缺血时间并改善臂丛神经损伤修复。
