Subclavian artery injury secondary to blunt trauma successfully managed by median sternotomy with supraclavicular extension: A case report and literature review

Abstract

Introduction

Subclavian artery injury secondary to blunt trauma is rare and only a few cases have been documented in the literature. Subclavian arteries are protected by the clavicles, ribs, and chest wall. Clinical management and surgical approach vary depending on the specific injury. We present the case of a 50 year old male with blunt right subclavian transection.

Case presentation

A 50-year-old male presented after being struck by a train. On exam, the patient had open injuries to the right upper chest/extremity. CTA showed a transection of the mid right subclavian artery along with a long traumatic occlusion distal to the defect. The patient was taken to the operating room where median sternotomy with supraclavicular extension was used to expose the transected ends of the subclavian artery and successfully perform a bypass graft. After a long hospital stay, he had a near-full functional recovery.

Discussion

Blunt subclavian injury is rare and carries a high mortality. Adequate intervention requires prompt identification and proper surgical approach for repair. Median sternotomy offers the best approach to visualize the proximal right subclavian artery. Extension with a supraclavicular incision can be necessary for distal control. This approach offered timely intervention, which ultimately saved his life and allowed for return of pre-trauma functional status.

Conclusion

Prompt identification of subclavian artery injury is paramount as such injuries carry a high mortality. Median sternotomy with supraclavicular extension is an appropriate open surgical approach to successfully manage proximal right subclavian artery injuries.

Highlights

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  Proximal right subclavian artery injuries secondary to blunt trauma are rare and often associated with significant comorbidities and higher mortality.

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  Prompt surgical intervention adequately prevented death in our patient and allowed for full functional recovery.

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  Management of such subclavian artery injuries typically require open surgical intervention given the extent of damage.