Subclavian artery avulsion following blunt trauma: A case report and literature review

INTRODUCTION: Subclavian artery injuries are rare and are associated with a high morbidity and mortality. The majority of patients with blunt trauma to the subclavian artery succumb to their injury before reaching a hospital. In-hospital mortality remains high. PRESENTATION OF CASE: We report the case of a 30-year-old male who presented with complete traumatic subclavian artery avulsion after a motorcycle collision. He presented in hemorrhagic shock. Temporary hemostatic control was achieved with endovascular balloon occlusion followed by operative intervention. DISCUSSION: Prompt diagnosis and meticulous management including early transfusion, when indicated, are necessary to salvage both the patient’s life and limb from such severe injuries. Intra-operative diagnosis of subclavian artery injury is most common due to the hemodynamic instability of most patients with such injuries; however, conventional angiography and computed tomography angiography are useful diagnostic modalities as well. Temporizing measures such as endovascular balloon occlusion to obtain vascular control may serve as a valuable adjunct to surgical repair. CONCLUSION: Repair of a subclavian artery injury is challenging for even the most experienced of surgeons. Endovascular techniques can be therapeutic or used as an adjunct to control bleeding ad allow an open repair.