Original scientific paper
Blunt Trauma of Thorax with Subclavian and Axillary Artery Lesion - Case Report
Jurica Fudurić
; General Hospital Karlovac, Department of Surgery, Karlovac, Croatia
Željko Erdeljac
; General Hospital Karlovac, Department of Surgery, Karlovac, Croatia
Ivan Frketić
; General Hospital Karlovac, Department of Surgery, Karlovac, Croatia
Matija Miletić
; General Hospital Karlovac, Department of Surgery, Karlovac, Croatia
Ana Šoštarić Zadro
; Special Hospital for Lung Diseases, Department of Radiology, Zagreb, Croatia
Ivan Bačić
; General Hospital Zadar, Department of Surgery, Zadar, Croatia
Žarko Rašić
; University of Zagreb, University Hospital »Sveti Duh«, Department of Surgery, Zagreb, Croatia
Zvonko Zadro
; University of Zagreb, University Hospital »Sveti Duh«, Department of Surgery, Zagreb, Croatia
Miran Martinac
; University of Zagreb, University Hospital »Sveti Duh«, Department of Surgery, Zagreb, Croatia
Eduard Missoni
; University of Zagreb, Faculty of Transport and Traffic Sciences, Department of Transportation Planning, Zagreb, Croatia
Abstract
We report a rare case of blunt trauma of the axillary artery in the 20-year-old man who was injured as a motorcycle rider and received severe body injuries. Injuries included severe trauma of the left lower leg with contusion and extensive soft tissue and bone trauma of these regions with poor general condition and with the presence of clinical signs of traumatic shock. Upon arrival, we found that in addition to earlier clearly visible trauma to the leg, there is a hematoma of the medial side of the left supraclavicular region and the absence of the radial artery pulse with paralysis of the left arm. Given the clinical findings, emergency radiological examination is made to the patient (X-ray, US, CDFI, MSCT - angiography) and we found out that there is trauma of axillary artery with clear signs of thrombosis of extra thoracic part of subclavian artery due to its transition in to the axillary artery. After hemodynamic stabilization, above knee amputation of the left leg is made and emergency exploration of earlier mentioned arteries. Bypass of the damaged arteries with synthetic graft 6mm in diameter was made. Control MSCT angiography showed normal flow in the arterial tree of the whole left hand and the MRI of the cervical spine and shoulder girdle did not found lesions of the brachial plexus. SSEP demonstrate the absence of pulses on the left hand. Patient on regular check-ups showed normal general condition, with adequate passable graft and pronounced paralysis on the left hand. In the process of rehabilitation physiotherapy was also included. Blunt trauma to the axillary artery is an extremely rare example of trauma of blood vessels which makes only 0.03% of all vascular injuries.
Keywords
subclavian; artery; thrombosis; reconstruction
Hrčak ID:
128225
URI
Publication date:
30.9.2014.
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