the incidence of subclavian arterial rupture among 1181 thoracic traumatic injuries was 0.4% [4]; a recent study by Shalhub and coll. reported a 47% incidence of subclavian arterial rupture above all the blunt thoracic outlet arterial

injuries selleck (BTOAI) [5]; furthermore, clavicular fractures were cited as the cause of 50% of traumatic subclavian artery injuries in another article by Kendall and coll. [1]. Subclavian artery injuries occurs from either elongation (stretching) or laceration mechanisms. Elongation is characteristically associated with a blunt force applied to the anterior shoulder or clavicle, as in motor vehicle crashes. This force is transmitted to fixed points along the vessel, typically the origin of the vertebral and internal thoracic artery where the vessel is then pulled apart. Laceration to the subclavian artery ensues from bony fragments produced by a fractured first rib or clavicle. The fracture is displaced into the vessel by the traction of associated chest

wall muscles. Fractured clavicle has been cited as the cause of 50% of traumatic subclavian arterial injuries [1]. Subclavian arterial rupture is an uncommon complication of blunt thoracic trauma, and must be carefully ruled out because of its poor prognosis; in 1983 Sturm and Cicero have devised five criteria that should lead the examining learn more physician to confirm the suspicion of arterial injury PAK6 with arch aortography.

These criteria include first rib fracture, diminished or absent radial pulses, palpable supraclavicular hematoma, chest roentgenogram demonstrating a widened mediastinum or hematoma over the area of the subclavian artery, and brachial plexus palsy [6]. Physical examination of the upper limb must focus on skin color, temperature, sensation, hand motility as well as radial pulse. CT represents a key diagnostic exam, while selective arteriography offers both diagnostic accuracy and an operative approach. Once identified, these injuries have historically been managed with a conventional surgical approach, associated with its own morbidity. Open repair is technically challenging and associated with significant morbidity and mortality for a variety of reasons. Exposure to obtain proximal control requires either a median sternotomy for the innominate and proximal right subclavian artery or a high anterolateral thoracotomy with potential clavicular resection for the proximal left subclavian artery. Such extensive incisions require lengthy healing and rehabilitation and carry significant morbidities. Endovascular treatment represents a less invasive approach to these vascular injuries; furthermore, it offers less blood loss and a lesser invasive approach to an anatomically challenging problem [5].