THE MANAGEMENT OF SUBCLAVIAN ARTERY INJURIES FOLLOWING BLUNT THORACIC TRAUMA
THE MANAGEMENT OF SUBCLAVIAN ARTERY INJURIES FOLLOWING BLUNT THORACIC TRAUMA
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DOI：
10.1016/s0003-4975(10)62234-5
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发表时间：
1984-01-01
影响因子：
4.6
通讯作者：
PERRY, JF
中科院分区：
文献类型：
--
作者：
STURM, JT;DORSEY, JS;PERRY, JF
本文回顾了15例闭合性锁骨下动脉破裂患者的临床资料。体格检查表现为动脉低血压、单侧桡动脉搏动缺失、臂丛神经麻痹、锁骨上血肿。胸部X线表现包括纵隔增宽、心尖胸膜血肿和第一肋骨骨折。患者(14例)存活，接受血管造影和手术。采用一期吻合、人工血管和静脉间置血管重建动脉连续性。1例完全性臂丛神经麻痹患者行假性动脉瘤结扎术。上肢截肢1例。术后死亡2例。临床上可能怀疑锁骨下动脉闭合性损伤。缺乏上肢脉搏、纵隔较宽、持续的胸腔出血和持续性低血压决定了行主动脉造影的必要性。血管造影的相关指征包括臂丛神经麻痹、心尖胸膜血肿和第一肋骨骨折。
The records of 15 patients who sustained blunt rupture of the subclavian artery were reviewed. The findings on physical examination included arterial hypotension, unilateral absence of the radial pulse, brachial plexus palsy and supraclavicular hematoma. The chest roentgenographic findings included wide mediastinums, apical pleural hematomas and 1st rib fractures. Patients (14) survived to undergo angiography and operation. Arterial continuity was restored by primary anastomosis, synthetic grafts and venous interposition grafts. Ligation of a pseudoaneurysm was carried out in 1 patient with a complete brachial plexus palsy. Amputation of an upper extremity was required in 1 patient. Two patients died postoperatively. Blunt subclavian artery injuries may be suspected clinically. Absent upper extremity pulses, a wide mediastinum, unrelenting thoracic hemorrhage and persistent hypotension dictate the necessity for aortography. Relative indications for angiography include brachial plexus palsy, apical pleural hematoma and a fractured 1st rib.