Open AccessEndovascular Instead of Open Surgical Repair of Axillosubclavian Artery Injuries: An Evolving Paradigm Shift
Author(s) -
Shreya Jalali,
Derek J. Roberts,
Megan Brenner,
Joseph J. DuBose,
Laura J. Moore,
Adam Power
Publication year - 2022
Publication title -
journal of endovascular resuscitation and trauma management
Language(s) - English
Resource type - Journals
eISSN - 2003-539X
pISSN - 2002-7567
DOI - 10.26676/jevtm.v5i3.227
Subject(s) - medicine , paradigm shift , endovascular surgery , surgery , safer , general surgery , computer science , computer security , philosophy , epistemology
Axillosubclavian injuries (ASI) comprise a small proportion of vascular injuries, yet their morbidity and mortality is high. This is often attributable to non-compressible bleeding in the apical thorax, hemodynamic instability, and the anatomically challenging location of these vessels making them difficult to access and control quickly. While the traditional management of ASI was with open surgical repair (OSR), recent years have seen an evolution towards less invasive endovascular repair (EVR). In patients with these injuries, EVR may be a safer alternative that achieves similar immediate results with significantly lower complication and mortality rates than the highly morbid open surgical option. In this article, we review and compare the two approaches, providing an overview of patient selection, anatomic considerations, techniques, postoperative management, and outcomes. With the advent of EVTM and more trauma team members capable of endovascular management of vascular trauma, a paradigm shift towards EVR for ASI is taking place.