Blunt versus penetrating subclavian artery injury: Presentation, injury pattern, and outcome

Background: Subclavian artery (SCA) injuries are rare vascular injuries and may be difficult to manage. The majority of SCA injuries are secondary to penetrating trauma. The purpose of this report is to examine the injury pat terns, diagnostic and therapeutic approaches, and outcome of patients with blunt and penetrating SCA injuries. Methods: Retrospective review Results: Fifty-six patients sustained SCA injuries (25 blunt, 31 penetratin g). SCA injury location was evenly distributed between the proximal, middle , and distal SCA after penetrating trauma; proximal injuries were rare (2 o f 25) with blunt mechanisms. A radial arterial pulse deficit was present in only 3 of 25 blunt injuries and 9 of 31 penetrating injuries. Complication s occurred more commonly in both groups of patients with initial systolic b lood pressures less than 90 mm Hg, Survival was 76% in blunt and 81% in pen etrating groups; limb salvage was similar (92% in blunt and 97% in penetrat ing groups). Complete brachial plexus injuries were more common with blunt injuries. Conclusion: SCA injuries are rare vascular injuries with an associated high morbidity and mortality, regardless of mechanism, Blunt mechanisms result in more middle and distal injuries and more frequent complete brachial plex us injuries. Complications are related to the hemodynamic status of the pat ient upon presentation, and not to mechanism of injury.