Contemporary management of civilian penetrating cervicothoracic arterial injuries.

Background: The management of arterial injury at the thoracic outlet has long hinged on the fundamental principles of extensile exposure and vascular anastomosis. Nonetheless, treatment options for such injuries have evolved to include both endovascular stent placement and temporary vascular shunts. The purpose of this study was to evaluate our recent experience with penetrating cervicothoracic arterial injuries in light of these developments in trauma care. Methods: Patients with penetrating injuries to the innominate, carotid, subclavian, or axillary arteries managed at a single civilian trauma center between 2000 and 2013 were categorized as the modern era (ME) cohort. The management strategies and outcomes pertaining to the ME group were compared to those of previously reported experience (PE) concerning injuries to the innominate, carotid, subclavian, or axillary arteries at the same institution from 1974 -1988. Results: Over the two eras, there were 202 patients: 110 in the ME group and 92 in the PE group. The majority of injuries in both groups were managed with primary repair (45% vs. 46%, p = 0.89). A similar proportion of injuries in each group were managed with anticoagulation alone (14% vs. 10%, p = 0.40). In the ME group, two cases were managed with temporary shunt placement, and endovascular stent placement was performed in 12 patients. Outcomes were similar between groups (bivariate comparison): mortality (ME:15% vs. PE:14%, p = 0.76), amputation following subclavian or axillary artery injury (ME:5% vs. PE:4%, p = 0.58), and post-treatment stroke following carotid injury (ME:2% vs. PE:6%, p = 0.57). Conclusions: Experience with penetrating arterial cervicothoracic injuries at a high-volume urban trauma center remained remarkably similar with respect to both anatomic distribution of injury and treatment. Conventional operative exposure and repair remains the cornerstone of treatment for the majority of civilian cervicothoracic arterial injuries. Level of Evidence: Therapeutic/care management study, level V. (C) 2016 Lippincott Williams & Wilkins, Inc.

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