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penetrating vascular trauma: bleeding subclavian avf

Karim Brohi karim at trauma.org
Sun Apr 30 17:37:44 BST 2006


We've done 3 of these now - and used proximal balloon control of the subclavaian as an adjunct to open surgery in two more.  Two
subsequently occluded, one required no reintervention as the hand was viable, one required a brachial thrombectomy and re-stenting
(as I recall).

Anyone else on the list done this.  Perhaps we should pool and write-up our experiences?


-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of docrickfry at aol.com
Sent: 23 April 2006 17:42
To: trauma-list at trauma.org
Subject: Re: penetrating vascular trauma: bleeding subclavian avf 

I missed this first time around too--
This is a perfectly valid approach in my view for such areas as the thoracic outlet that you show, Zone 3 neck, Zone I neck,
thoracic inlet, for which phys exam is not that accurate and surgical access relatively difficult--stents like these are of great
value in these areas to avoid major surgery--hopefully long term followup will bear out the safety and cost effectiveness of this
-----Original Message-----
From: SJASMD at aol.com
To: trauma-list at trauma.org
Sent: Sun, 23 Apr 2006 09:47:31 EDT
Subject: penetrating vascular trauma: bleeding subclavian avf 

Tried to send this with an image but no one ever commented. I spoke  to ron 
gross who said it never was received by the message board, although i got  it
i was surprised by lack of comments so I will send the post again but  attach 
rather than embed the image.
In a message dated 4/19/2006 11:07:47 A.M. Eastern Standard Time,  
roydanks at hotmail.com writes:

EAST has  published guidelines for these.  I generally follow them, but will  
deviate as needed.

This is how I handle them:

1)  Physical  exam: 
Wound:  Any signs of expanding  hematoma or pulsatile mass?  If so, go to OR

I had a recent interesting "deviation" from that recommendation
28 year old male sustained stab wound of the left shoulder. on admission  
hypotensive but responded with volume with improved pulses but bleeding from the  

wound which was  managed by pressure.
take a deep breath, trauma surgeons.....
patient brought to angio with manual pressure applied. attached angio  showed 
a subclavian arteriovenous fistula. This was treated by stent graft which  
controlled the bleeding and repaired the vessel in about forty  minutes. 
he was discharged on fourth hospital day. Followup angio at five  weeks 
showed good flow and equal upper extremity blood  pressures.
 i see more of this happening in the future

[Image removed] 
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