PDF(Pubmed)
Abstract：
BACKGROUND: Subclavian arterial injury due to blunt trauma is rare but can have devastating outcomes. Massive hemorrhage or limb ischemia might develop depending on the extent of damage, and open repair might be necessary to salvage the limb. However, life-saving treatments should be prioritized in critically unstable patients.
METHODS: A 21-year-old male patient who was transferred to our trauma center following a motorcycle accident. Abdominal and chest computed tomography (CT) revealed right renal injury and massive hemothorax with several rib fractures in the right chest.
METHODS: Right renal injury with multiple extravasations and right 8th intercostal arterial injury were detected during angiography. Emergent exploration with lateral thoracotomy was performed to manage right hemothorax. Pulsating bleeding from the thoracic roof observed in the operative field suggested a subclavian arterial injury. The unstable vital signs did not recover despite massive transfusion, and his right arm had already stiffened. Therefore, endovascular approach was adopted and the second portion of the right subclavian artery was embolized using microcoils and thrombin.
RESULTS: Postoperative intensive care unit management performed to resuscitate patient from multiorgan failure included continuous renal replacement therapy (CRRT). After confirming the demarcation lines, transhumeral amputation of the right arm was performed on admission day 12. The patient recovered from multiorgan failure for more than 3 weeks after the accident; however, the patient survived.
CONCLUSIONS: Limb salvage, albeit critical for quality of life, is not possible in some cases where life-saving measures require its sacrifice. In these cases, quick decision-making by the surgeon is paramount for patient survival. As illustrated in this case, endovascular approaches should be considered less invasive measures to save the patient\'s life.
METHODS: A 21-year-old male patient who was transferred to our trauma center following a motorcycle accident. Abdominal and chest computed tomography (CT) revealed right renal injury and massive hemothorax with several rib fractures in the right chest.
METHODS: Right renal injury with multiple extravasations and right 8th intercostal arterial injury were detected during angiography. Emergent exploration with lateral thoracotomy was performed to manage right hemothorax. Pulsating bleeding from the thoracic roof observed in the operative field suggested a subclavian arterial injury. The unstable vital signs did not recover despite massive transfusion, and his right arm had already stiffened. Therefore, endovascular approach was adopted and the second portion of the right subclavian artery was embolized using microcoils and thrombin.
RESULTS: Postoperative intensive care unit management performed to resuscitate patient from multiorgan failure included continuous renal replacement therapy (CRRT). After confirming the demarcation lines, transhumeral amputation of the right arm was performed on admission day 12. The patient recovered from multiorgan failure for more than 3 weeks after the accident; however, the patient survived.
CONCLUSIONS: Limb salvage, albeit critical for quality of life, is not possible in some cases where life-saving measures require its sacrifice. In these cases, quick decision-making by the surgeon is paramount for patient survival. As illustrated in this case, endovascular approaches should be considered less invasive measures to save the patient\'s life.
摘要：
背景：闭合性损伤引起的锁骨下动脉损伤很少见，但可能具有破坏性后果。大量出血或肢体缺血可能取决于损伤的程度，和开放修复可能是必要的，以挽救肢体。然而,在危重不稳定的患者中，应优先考虑挽救生命的治疗。
方法：一名21岁的男性患者，在摩托车事故后被转移到我们的创伤中心。腹部和胸部计算机断层扫描（CT）显示右肾损伤和大量血胸，右胸部有几处肋骨骨折。
方法：在血管造影期间检测到右肾损伤伴多发外渗和右第8肋间动脉损伤。紧急探查侧方开胸以治疗右血胸。在手术中观察到的胸顶脉动出血表明锁骨下动脉损伤。尽管大量输血，但不稳定的生命体征仍未恢复，他的右臂已经僵硬了。因此,采用血管内入路，使用微线圈和凝血酶栓塞右锁骨下动脉的第二部分。
结果：为使多器官衰竭患者复苏而进行的术后重症监护病房管理包括连续性肾脏替代疗法（CRRT）。确认分界线后,在入院第12天进行右臂经瘤截肢术.患者在事故发生后3周以上从多器官功能衰竭中康复；然而，病人幸存下来。
结论：肢体抢救，尽管对生活质量至关重要，在某些情况下，救生措施需要牺牲是不可能的。在这些情况下,外科医生的快速决策对于患者的生存至关重要。如这种情况所示，血管内途径应被视为较少侵入性的措施，以挽救患者的生命。
方法：一名21岁的男性患者，在摩托车事故后被转移到我们的创伤中心。腹部和胸部计算机断层扫描（CT）显示右肾损伤和大量血胸，右胸部有几处肋骨骨折。
方法：在血管造影期间检测到右肾损伤伴多发外渗和右第8肋间动脉损伤。紧急探查侧方开胸以治疗右血胸。在手术中观察到的胸顶脉动出血表明锁骨下动脉损伤。尽管大量输血，但不稳定的生命体征仍未恢复，他的右臂已经僵硬了。因此,采用血管内入路，使用微线圈和凝血酶栓塞右锁骨下动脉的第二部分。
结果：为使多器官衰竭患者复苏而进行的术后重症监护病房管理包括连续性肾脏替代疗法（CRRT）。确认分界线后,在入院第12天进行右臂经瘤截肢术.患者在事故发生后3周以上从多器官功能衰竭中康复；然而，病人幸存下来。
结论：肢体抢救，尽管对生活质量至关重要，在某些情况下，救生措施需要牺牲是不可能的。在这些情况下,外科医生的快速决策对于患者的生存至关重要。如这种情况所示，血管内途径应被视为较少侵入性的措施，以挽救患者的生命。
