Contemporary management of civilian penetrating cervicothoracic arterial injuries

Jordan A. Weinberg, Andrew H. Moore, Louis J. Magnotti, Rebecca J. Teague, Tyler A. Ward, Joshua B. Wasmund, Elena M.P. Lamb, Thomas J. Schroeppel, Stephanie A. Savage, Gayle Minard, George O. Maish, Martin Croce, Timothy C. Fabian

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: The management of arterial injury at the thoracic outlet has long hinged on the fundamental principles of extensile exposure and vascular anastomosis. Nonetheless, treatment options for such injuries have evolved to include both endovascular stent placement and temporary vascular shunts. The purpose of this study was to evaluate our recent experience with penetrating cervicothoracic arterial injuries in light of these developments in trauma care. METHODS: Patients with penetrating injuries to the innominate, carotid, subclavian, or axillary arteries managed at a single civilian trauma center between 2000 and 2013 were categorized as the modern era (ME) cohort. The management strategies and outcomes pertaining to theME group were compared to those of previously reported experience (PE) concerning injuries to the innominate, carotid, subclavian, or axillary arteries at the same institution from 1974 to 1988. RESULTS: Over the two eras, there were 202 patients: 110 in the ME group and 92 in the PE group. Most of the injuries in both groups were managed with primary repair (45% vs. 46%; p = 0. 89). A similar proportion of injuries in each group was managed with anticoagulation alone (14% vs. 10%; p = 0. 40). In the ME group, two cases were managed with temporary shunt placement, and endovascular stent placement was performed in 12 patients. Outcomes were similar between the groups (bivariate comparison): mortality (ME, 15% vs. PE, 14%; p = 0. 76), amputation following subclavian or axillary artery injury (ME, 5% vs. PE, 4%; p = 0. 58), and posttreatment stroke following carotid injury (ME, 2% vs. PE, 6%; p = 0. 57). CONCLUSIONS: Experience with penetrating arterial cervicothoracic injuries at a high-volume urban trauma center remained remarkably similar with respect to both anatomic distribution of injury and treatment. Conventional operative exposure and repair remain the cornerstone of treatment for most civilian cervicothoracic arterial injuries.

Original languageEnglish (US)
Pages (from-to)302-306
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume81
Issue number2
DOIs
StatePublished - Jan 1 2016

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Wounds and Injuries
Axillary Artery
Subclavian Artery
Trauma Centers
Carotid Arteries
Stents
Blood Vessels
Thoracic Injuries
Amputation
Therapeutics
Stroke
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Weinberg, J. A., Moore, A. H., Magnotti, L. J., Teague, R. J., Ward, T. A., Wasmund, J. B., ... Fabian, T. C. (2016). Contemporary management of civilian penetrating cervicothoracic arterial injuries. Journal of Trauma and Acute Care Surgery, 81(2), 302-306. https://doi.org/10.1097/TA.0000000000001103

Contemporary management of civilian penetrating cervicothoracic arterial injuries. / Weinberg, Jordan A.; Moore, Andrew H.; Magnotti, Louis J.; Teague, Rebecca J.; Ward, Tyler A.; Wasmund, Joshua B.; Lamb, Elena M.P.; Schroeppel, Thomas J.; Savage, Stephanie A.; Minard, Gayle; Maish, George O.; Croce, Martin; Fabian, Timothy C.

In: Journal of Trauma and Acute Care Surgery, Vol. 81, No. 2, 01.01.2016, p. 302-306.

Research output: Contribution to journalArticle

Weinberg, JA, Moore, AH, Magnotti, LJ, Teague, RJ, Ward, TA, Wasmund, JB, Lamb, EMP, Schroeppel, TJ, Savage, SA, Minard, G, Maish, GO, Croce, M & Fabian, TC 2016, 'Contemporary management of civilian penetrating cervicothoracic arterial injuries', Journal of Trauma and Acute Care Surgery, vol. 81, no. 2, pp. 302-306. https://doi.org/10.1097/TA.0000000000001103
Weinberg, Jordan A. ; Moore, Andrew H. ; Magnotti, Louis J. ; Teague, Rebecca J. ; Ward, Tyler A. ; Wasmund, Joshua B. ; Lamb, Elena M.P. ; Schroeppel, Thomas J. ; Savage, Stephanie A. ; Minard, Gayle ; Maish, George O. ; Croce, Martin ; Fabian, Timothy C. / Contemporary management of civilian penetrating cervicothoracic arterial injuries. In: Journal of Trauma and Acute Care Surgery. 2016 ; Vol. 81, No. 2. pp. 302-306.
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abstract = "BACKGROUND: The management of arterial injury at the thoracic outlet has long hinged on the fundamental principles of extensile exposure and vascular anastomosis. Nonetheless, treatment options for such injuries have evolved to include both endovascular stent placement and temporary vascular shunts. The purpose of this study was to evaluate our recent experience with penetrating cervicothoracic arterial injuries in light of these developments in trauma care. METHODS: Patients with penetrating injuries to the innominate, carotid, subclavian, or axillary arteries managed at a single civilian trauma center between 2000 and 2013 were categorized as the modern era (ME) cohort. The management strategies and outcomes pertaining to theME group were compared to those of previously reported experience (PE) concerning injuries to the innominate, carotid, subclavian, or axillary arteries at the same institution from 1974 to 1988. RESULTS: Over the two eras, there were 202 patients: 110 in the ME group and 92 in the PE group. Most of the injuries in both groups were managed with primary repair (45{\%} vs. 46{\%}; p = 0. 89). A similar proportion of injuries in each group was managed with anticoagulation alone (14{\%} vs. 10{\%}; p = 0. 40). In the ME group, two cases were managed with temporary shunt placement, and endovascular stent placement was performed in 12 patients. Outcomes were similar between the groups (bivariate comparison): mortality (ME, 15{\%} vs. PE, 14{\%}; p = 0. 76), amputation following subclavian or axillary artery injury (ME, 5{\%} vs. PE, 4{\%}; p = 0. 58), and posttreatment stroke following carotid injury (ME, 2{\%} vs. PE, 6{\%}; p = 0. 57). CONCLUSIONS: Experience with penetrating arterial cervicothoracic injuries at a high-volume urban trauma center remained remarkably similar with respect to both anatomic distribution of injury and treatment. Conventional operative exposure and repair remain the cornerstone of treatment for most civilian cervicothoracic arterial injuries.",
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AU - Ward, Tyler A.

AU - Wasmund, Joshua B.

AU - Lamb, Elena M.P.

AU - Schroeppel, Thomas J.

AU - Savage, Stephanie A.

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