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Blunt traumatic injury to the subclavian, axillary or brachial artery is uncommon and could have devastating consequences. Historically open repair is performed however reports of successful endovascular treatments are increasing. A case is described of a seventy one-year-old patient with a blunt injury to his right arm after being crushed in a closing hydraulic door of a truck. He sustained a traumatic dissection of his right brachial artery with associated nerve injury to the brachial plexus. After trauma resuscitation he was successfully treated in the hybrid operation room. Through the common femoral artery a helical stent (Supera) was placed in the injured brachial artery. Postoperative recovery was without complications. Additional treatment for the nerve injury was performed several months after trauma by the neurosurgeon. Functional recovery of his right arm was good except for fine motoric functioning which is still recovering. A review of the literature was performed to identify endovascular repair of blunt traumatic injury to the upper extremity. A total of 28 papers described 55 patients who underwent 56 procedures for subclavian, axillary and brachial injuries. The subclavian artery was affected and treated in 36 patients, in 16 patients axillary injury was treated and only 4 brachial arteries received endovascular repair. Technical success rate of endovascular treatment is good and stent graft patency rates are sufficient. Type of injury which was treated, the follow up technique, anticoagulant therapy and follow up duration varied extensively in the literature. Endovascular treatment of blunt arterial trauma to the upper extremity appears to be feasible. No definite conclusion can be drawn concerning best type of stent graft, best follow up regime or post-operative medical treatment. Treating a patient in a hybrid operation room seems advisable to facilitate conversion to open treatment or treat associated traumatic injuries if necessary.

Endovascular Treatment of Blunt Traumatic Injury to the Brachial Artery: Case Report and Review of the Literature