Endovascular repair of subclavian/axillary artery injury with a covered stent. A case report and review of literature

Experience with and acceptance of endovascular repair of arch vessel injuries continues to increase. This manuscript reports the case of a 65-year-oldman with a gunshot wound to the right supraclavicular area with a hematoma, pulsating mass and loss of neurological function of the right upper extremity. As he was hemodynamically stable, a computed tomography angiogram was performed and it demonstrated a 6 cm right subclavian/axillary artery pseudoaneurysm. The patient was taken to the angiogram/hybrid room and an arch angiogram was performed. A selective right subclavian angiogram was performed and a covered stent was deployed across the pseudoaneurysm and a completion angiogram showed complete exclusion with normal runoff to the upper extremity. In conclusion, penetrating subclavian/axillary artery trauma can be successfully managed with minimal morbidity via early utilization of endovascular covered stent therapy. A literature review suggests that the endovascular approach will soon be the standard of care for traumatic disruption of subclavian arteries.