Isabella Caicedo-Holguin (Cali / CO), Leidy Castro (Cali / CO), Juan Pablo Carbonell (Cali / CO), Cesar Torres (Cali / CO), Alberto Federico Garcia (Cali / CO), Camilo Salazar (Cali / CO)
Abstract text (incl. references and figure legends)
Introduction: Open treatment of subclavian and proximal axillar injuries requires complex exposures. Endovascular modalities are attractive, and their use has increased in the last two decades. We aimed to identify characteristics associated with a higher probability of endovascular treatment.
Methods: We performed a retrospective analysis of the patients with axillo-subclavian injuries treated at a high-complexity trauma hospital in Cali, Colombia, from 2015 to 2021. Demographics, trauma characteristics, and details of the lesions and the treatment were registered. Continuous variables were compared with the Wilcoxon-Mann Whitney test. Categorical variables with Fisher's Exact test.
Results: A total of 79 patients were treated, 89.5% male. Median age was 26.5 years. The most frequent mechanisms were penetrating (82.3%). Twenty patients (25.3%) were treated by endovascular means, in four of them in combination with open surgery. Endovascular treatment was significantly more frequent in blunt trauma patients, in subjects with systolic blood pressure higher than 75 mm Hg, and in subclavian artery injuries. Remarkably, 46.2% of the patients with systolic blood pressure between 76 and 89 mm Hg responded to resuscitation, and it was possible to study and treat them by endovascular means. The risk of requiring open management was higher in patients with hard signs of arterial injury, axillary artery injury, or associated venous injury.Ten patients (12.8%) died, all in the open surgery group.
Conclusions: One-fourth of the cases could receive endovascular treatment. If immediate endovascular therapy is available, most hemodynamically normal and responder patients are candidates for endovascular treatment.
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