Endovascular Management of Axillo-subclavian Injuries in Puerto Rico: Ten-year Experience

Injuries to the axillosubclavian vessels have a high degree of morbidity and mortality, despite representing only ∼9% of all vascular injuries. Axillosubclavian injuries can be treated using either an open or an endovascular approach, with recent data suggesting that for appropriately selected patients, endovascular treatment is associated with improved outcomes. Our goal was to describe the characteristics and outcomes of all axillosubclavian injuries repaired using an endovascular approach at our institution. An institutional review board-approved case-series analysis was conducted of data from the Puerto Rico Trauma Hospital (PRTH) registry and operation reports and verified from a surgeon-specific registry. The following domains were analyzed: sociodemographic profile, injury characteristics, hospital course, and outcomes (ie, hospital length of stay and mortality). The results were calculated as the mean ± standard deviation or frequencies and proportions, as appropriate. A total of 13,974 admissions to the PRTH occurred from January 2011 to January 2021. A total of 15 patients (0.11%) had undergone endovascular procedures to treat an axillosubclavian injury. Of the 15 patients, 13 (86.7%) were male, with a median age of 32 years (range, 17-69 years). Of the cohort, 13 patients (86.7%) had had public health insurance and 1 (6.7%) was uninsured. The most common type of injury was penetrating (nine patients; 60.0%) followed by blunt (five patients; 33.3%) and iatrogenic (one patient; 6.7%). A gunshot wound was the most common mechanism of injury (eight patients; 53.3%). The median injury severity score for this cohort was 20 (range, 9-75). The most common diagnosis was a pseudoaneurysm (n = 9; 60.0%), followed by transection (n = 4; 26.6%) and fistula (n = 2; 13.3%). The median hospital length of stay was 26 days (range, 3-84 days), and two patients (13.3%) had died while hospitalized. The median follow-up for this trauma population was 9.4 months (range, 0.4-70.4 months). Axillosubclavian vessel injuries are an infrequent, but lethal, condition affecting a healthy young population in Puerto Rico. The results of our study have shown that endovascular repair of axillosubclavian vessels is a safe and successful method of treatment. It has been performed with good results at the PRTH for 10 years. We will continue gathering our long-term follow-up data to aid with the surveillance of this population.