Evaluation of Subclavian, Thoracic Aorta and Innominate Artery Injuries in Blunt Trauma Mechanisms: A Systematic Review of Case Reports and Case Series

Abstract

Background: Blunt thoracic arterial injuries are one of the uncommon presentations in trauma clinical experiences. Most reports are case reports and case series and no significantly consolidated data is available. This is an attempt to organize case reports and case series.
Methodology: Pubmed and Google scholar were utilized to find case reports and case series on each artery separately with data search limited to publications between 2000 and 2019. The retrieved data are extracted using tables with specific components for data interpretation and the data was finally entered and analyzed using SPSS version 23.
Results: The mean ages were between 35.9 and 44.3 years with male proportions were 76.5% to 89.7% across the three groups of patients. Motor vehicle related injuries contributed between 49.9% and 81.2%in the three groups. Blood pressure/pulse deficit was recorded in 34.8% and 20,7% of patients with Subclavian and Innominate artery injuries respectively with chest pain and hemodynamic instability found in 23.5% and 20.5% of Aortic injury patients respectively. Clavicular fracture was evident in 42.2% of Subclavian artery injury patients. Computed tomography was performed in 21.7%, 47.1%, 27.6% of patients with Subclavian artery, Aortic and Innominate artery injuries respectively. Endovascular procedure was performed in 44.1% of patients with Subclavian artery injury.
Conclusion: Injury to Subclavian artery is relatively common among older population. Blood pressure or pulse discrepancy could point to either Subclavian or Innominate artery injury. Computed Tomography can be efficiently used in all the Arteries but there is poor experience regarding its use in Innominate artery injuries for this reason lower threshold for Conventional angiography should be preferred. Endovascular procedure can be considered in all patients but has to be individualized based on patient and facility factors.

Keywords: Aortic rupture; clavicular fracture; traumatic pseudoaneurysm; endovascular repair; cerebrovascular accident