Long-term results of stent graft treatment of subclavian artery injuries: Management of choice for stable patients?

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dc.contributor.authordu Toit D.F.
dc.contributor.authorLambrechts A.V.
dc.contributor.authorStark H.
dc.contributor.authorWarren B.L.
dc.date.accessioned2011-05-15T16:17:17Z
dc.date.available2011-05-15T16:17:17Z
dc.date.issued2008
dc.description.abstractBackground: The management of penetrating subclavian artery injuries poses a formidable surgical challenge. The feasibility of stent graft repair is already established. General use of this modality is not widely accepted due to concerns regarding the long-term outcome in a generally young patient population. We review our stent graft experience to examine long-term outcomes. Methods: All patients with penetrating subclavian artery injuries were evaluated for stent graft repair. Patients were excluded when hemodynamically unstable or unsuitable on other clinical and angiographic grounds. Patients were followed prospectively for early (<30 days) and late (>30 days) complications. Clinical and telephone evaluation, Doppler pressures, duplex Doppler, and angiography (when indicated), were used to asses patients at follow-up. Outcomes were recorded as technical success of procedure, graft patency, arm claudication, limb loss, the need for open surgical repair, the presence or absence of other complications, and death. Results: Fifty-seven patients underwent stent graft treatment during the 10-year period. Mean age was 34, and 91% were men. There were 53 stab wounds and four gunshot injuries. Pathology included false aneurysms (n = 42), arteriovenous fistula (n = 12), and three arterial occlusions. Early complications: One patient (2%) had a femoral puncture site injury which was managed with open surgical repair. One patient died early due to multiple organ failure related to concomitant injuries. Three patients (5%) presented with graft occlusion and nonlimb threatening ischemia in the first week after treatment. All three patients were managed successfully with a second endovascular intervention. Late complications: Twenty-five (44%) of the 57 patients with subclavian artery injuries were followed-up with a mean duration of 48 months. Two patients died as a result of fatal stab wounds months after their first injuries. Five patients (20%) and three patients (12%) presented with angiographically significant stenosis and occlusions, respectively. The stenotic lesions were successfully managed with endovascular intervention, and the occluded lesions were managed conservatively. No patient experienced life or limb loss or any incapacitating symptoms at the end of the study period. There was no need for conversion to open surgery. Conclusions: This study has reaffirmed the feasibility and safety of stent graft repair in treating stable patients with selected penetrating subclavian artery injuries. The results of this study also confirmed acceptable long-term follow-up without any limb or life threatening complications. We conclude that endovascular repair should be considered the first choice of treatment in stable patients with subclavian artery injuries. © 2008 The Society for Vascular Surgery.
dc.description.versionArticle
dc.identifier.citationJournal of Vascular Surgery
dc.identifier.citation47
dc.identifier.citation4
dc.identifier.issn07415214
dc.identifier.other10.1016/j.jvs.2007.11.009
dc.identifier.urihttp://hdl.handle.net/10019.1/14148
dc.subjectadult
dc.subjectangiography
dc.subjectarteriovenous fistula
dc.subjectartery injury
dc.subjectartery occlusion
dc.subjectarticle
dc.subjectdeath
dc.subjectDoppler echography
dc.subjectfalse aneurysm
dc.subjectfeasibility study
dc.subjectfemale
dc.subjectfollow up
dc.subjectgraft occlusion
dc.subjectgraft patency
dc.subjectgunshot injury
dc.subjecthemodynamics
dc.subjecthuman
dc.subjectlimb absence
dc.subjectlimb ischemia
dc.subjectlong term care
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectmultiple organ failure
dc.subjectoutcome assessment
dc.subjectpatient assessment
dc.subjectpenetrating trauma
dc.subjectpostoperative complication
dc.subjectpriority journal
dc.subjectprospective study
dc.subjectrisk assessment
dc.subjectstab wound
dc.subjectstenosis
dc.subjectsubclavian artery
dc.subjectsurgical patient
dc.subjecttelephone
dc.subjecttreatment duration
dc.subjectAdult
dc.subjectAneurysm, False
dc.subjectArterial Occlusive Diseases
dc.subjectArteriovenous Fistula
dc.subjectFemale
dc.subjectFollow-Up Studies
dc.subjectHumans
dc.subjectMale
dc.subjectProspective Studies
dc.subjectStents
dc.subjectSubclavian Artery
dc.subjectTreatment Outcome
dc.subjectWounds, Gunshot
dc.subjectWounds, Stab
dc.titleLong-term results of stent graft treatment of subclavian artery injuries: Management of choice for stable patients?
dc.typeArticle
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