Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.200007
Jornal Vascular Brasileiro
Therapeutic Challenge

Controle de danos para lesão de artéria subclávia

Damage control for subclavian artery injury

Adenauer Marinho de Oliveira Góes Junior; Mariana Pereira Maurity; Carlos Alberto Costa do Amaral

Downloads: 0
Views: 28

Resumo

Resumo: Os traumas penetrantes de vasos subclávios atingem mortalidade de até 60% em um cenário pré-hospitalar. A mortalidade no intraoperatório varia de 5-30%. Apresenta-se um caso de estratégia de controle de danos para um paciente com lesão na origem da artéria subclávia esquerda, através de ligadura, sem necessidade de outra intervenção, mantendo a viabilidade do membro superior esquerdo por meio de circulação colateral. Os autores fazem uma revisão sobre vias de acesso e estratégias de tratamento com ênfase em controle de danos para lesões de vasos subclávios.

Palavras-chave

traumatismos torácicos, artéria subclávia, síndrome do roubo subclávio, lesão do sistema vascular

Abstract

Mortality from penetrating traumas involving the subclavian vessels can be as high as 60% in pre-hospital settings. Operating room mortality is in the range of 5-30%. This paper presents a case in which a strategy for damage control was employed for a patient with an injury to the origin of the left subclavian artery, using subclavian ligation, with no need for any other intervention, and maintaining viability of the left upper limb via collateral circulation. The authors also review surgical approaches and treatment strategies with a focus on damage control in subclavian vessel injuries.

Keywords

chest traumas; subclavian artery; subclavian steal syndrome; vascular system injuries.

References

1 Carlos SF, Góis CC, Machado GF, et al. Traumatismo penetrante dos vasos subclávios: revisão da literatura a propósito de um caso clínico. Rev Port Cir. 2015;32:35-41.

2 Kou HW, Liao CH, Huang JF, et al. Eighteen years’ experience of traumatic subclavian vascular injury in a tertiary referral trauma center. Eur J Trauma Emerg Surg. 2018;45(6):973-978. PMid:30627733.

3 Waller CJ, Cogbill TH, Kallies KJ, et al. Contemporary management of subclavian and axillary artery Injuries: A Western Trauma Association multicenter review. J Trauma Acute Care Surg. 2017;83(6):1023-31. http://dx.doi.org/10.1097/TA.0000000000001645. PMid:28715360.

4 Maués Filho J, Hauter H. Tratamento endovascular de fístula traumática de vasos subclávios: relato de caso. J Vasc Bras. 2018;17(3):248-51. http://dx.doi.org/10.1590/1677-5449.010317.

5 Elkbuli A, Shaikh S, McKenney M, Boneva D. Subclavian artery avulsion following blunt trauma: A case report and literature review. Int J Surg Case Rep. 2019;61:157-60. http://dx.doi.org/10.1016/j.ijscr.2019.07.061. PMid:31376736.

6 Rotondo M, Bard M. Damage control surgery for thoracic injuries. Injury. Int. J. Care Injured. 2004;34(7):649-54. http://dx.doi.org/10.1016/j.injury.2004.03.002.

7 Inaba K, Aksoy H, Seamon M, et al. Multicenter evaluation of temporary intravascular shunt use in vascular trauma. J Trauma Acute Care Surg. 2015;80(3):359-63. http://dx.doi.org/10.1097/TA.0000000000000949. PMid:26713968.

8 Cheema M, Kirton O, Lukose B, Gallagher J. Ligation of the Subclavian Artery After Blunt Trauma Presenting as Massive Hemothorax. J Trauma. 2008;64(4):1126-30. http://dx.doi.org/10.1097/01.ta.0000195726.14064.0f. PMid:17413525.

9 Ferreira M, Souza A. Síndrome do roubo da subclávia: um relato de caso. Rev Med Saude Brasilia. 2017;6(2):220-7.

10 Ostovan M, Kojuri J, Dehghani P. Endovascular Repair of the Traumatic Dissection of the Subclavian–Axillary Artery: Report of Four Cases. J Teh Univ Heart Ctr. 2017;12(2):88-91. PMid:28828025.

11 Potter B, Pinto D. Subclavian Steal Syndrome. Circulation Journal of AHA. 2014;129(22):2320-3. http://dx.doi.org/10.1161/CIRCULATIONAHA.113.006653. PMid:24891625.

12 Papaiordanou F, Lourenço A, Ribeiro M Jr. Trauma na Zona Perigosa de Ziedler. Emergência Clínica. 2009;04(17):85-91.

13 Stranch E, Zarzaur B, Savage SA. Thinking outside the box: Re-evaluating the approach to penetrating cardiac injuries. Eur J Trauma Emerg Surg. 2017;43(5):617-22. http://dx.doi.org/10.1007/s00068-016-0680-7. PMid:27194248.

14 D’Souza RS, Law L. Open Heart Massage. StatPearls. Treasure Island, FL: StatPearls Publishing; 2020. [citado 2019 nov 26]. https://www.ncbi.nlm.nih.gov/books/NBK537230/

15 Teixeira P, DuBose J. Surgical management of vascular trauma. Surg Clin North Am. 2017;97(5):1133-55. http://dx.doi.org/10.1016/j.suc.2017.05.001. PMid:28958362.

16 Branco BC, DuBose JJ. Endovascular solutions for the management of penetrating trauma: an update on REBOA and axillo-subclavian injuries. Eur J Trauma Emerg Surg. 2016;42(6):687-94. http://dx.doi.org/10.1007/s00068-016-0739-5. PMid:27853843.

17 Branco B, Boutrous L, DuBose J, et al. Outcome comparison between open and endovascular management of axillosubclavian arterial injuries. J Vasc Surg. 2016;63(3):702-9. http://dx.doi.org/10.1016/j.jvs.2015.08.117. PMid:26506937.

18 Roberts D, Bobrovitz N, Zygun D, et al. Indications for use of damage control surgery and damage control interventions in civilian trauma patients: A scoping review. J Trauma Acute Care Surg. 2015;78(6):1187-96. http://dx.doi.org/10.1097/TA.0000000000000647. PMid:26151522.

19 Engelhardt M, Hinck D. Damage Control bei Gefäßverletzungen. Berlin: Springer Reference Medizin; 2018. p. 1-8.

20 De Ayala-Hillman R, Crespo-Martínez NA, García-Rodríguez O, Ramos-Meléndez EO, Rodriguez-Ortiz P. Traumatic vascular injury and its management with temporary intravascular shunts: A Puerto Rico Trauma Hospital’s Experience. P R Health Sci J. 2018;37(4):220-3. PMid:30548058.

21 Weinberg JA, Moore A, Magnotti L, et al. Contemporary management of civilian penetrating cervicothoracic arterial injuries. J Trauma Acute Care Surg. 2016;81(2):302-6. http://dx.doi.org/10.1097/TA.0000000000001103. PMid:27192470.

22 Lederman A, Paiva F, Saes G, Aun R. Ferimentos da artéria subclávia: Estudo retrospectivo de 20 casos. J Vasc Bras. 2005;4(2):149-54.

23 Aksoy M, Tunca F, Yanar H, Guloglu R, Ertekin C, Kurtoglu M. Traumatic Injuries to the Subclavian and Axillary Arteries: A 13-Year Review. Surg Today. 2005;35(7):561-5. http://dx.doi.org/10.1007/s00595-005-2990-y. PMid:15976953.

24 Wise D, Davies G, Coats T, Lockey D, Hyde J, Good A. Emergency thoracotomy: “how to do it”. Emerg Med J. 2005;22(1):22-4. http://dx.doi.org/10.1136/emj.2003.012963. PMid:15611536.

25 Molnar TF. Thoracic damage control surgery. J Thorac Dis. 2019;11(2, Suppl. 2):S158-66. http://dx.doi.org/10.21037/jtd.2018.11.32. PMid:30906580.
 


Submitted date:
01/20/2020

Accepted date:
05/18/2020

5f6a17910e8825a2259fefd0 jvb Articles

J Vasc Bras

Share this page
Page Sections