AGGRESSIVE MANAGEMENT OF VASCULAR INJURIES OF THE THORACIC OUTLET

Purpose: We present a review of 35 patients who underwent an operation for subclavian (n = 18) or axillary (n = 17) vessel injury. In some p atients, both an artery and a vein were damaged, resulting in a total of 30 arterial and 16 venous injuries. Methods: The wounding source in cluded a gunshot (n = 19), a stab wound (n = 9,) and blunt trauma (n = 7). Seven patients had hypotension and were taken immediately to the operating room. Seventeen patients had diminished or absent pulses, wh ereas 13 patients had normal pulses despite an arterial injury. Associ ated injuries included nerve injury (n = 15), pneumohemothorax (n = 5) , and fractures (n = 7). Angiography in 21 patients demonstrated an in timal flap (n = 8), extravasation (n = 5), a pseudoaneurysm (n = 3), a n arteriovenous fistula (n = 2), and occlusion (n = I). Two angiograms were normal, Arterial repair was accomplished by interposition graft (n = 17), primary repair (n = 9), patch angioplasty (n = 3,) and ligat ion (n = 1). Results: No functional deficits occurred in patients with an isolated vascular injury. Seven patients with associated brachial plexus injuries experienced severe disability One arm of a patient was amputated. Two patients died. Conclusions: The use of angiography hel ps to confirm and localize injuries. Prompt correction of the vascular injury avoids disability resulting from ischemia. Although the amputa tion rate is low with vascular repair; the functional disability resul ting from associated nerve injuries can be devastating.