Endovascular treatment of concomitant innominate and subclavian artery injury with pseudoaneurysms from a gunshot wound in a polytrauma patient
Issued Date
2022-01-01
Resource Type
ISSN
14604086
eISSN
14770350
Scopus ID
2-s2.0-85105534545
Journal Title
Trauma (United Kingdom)
Volume
24
Issue
1
Start Page
72
End Page
76
Rights Holder(s)
SCOPUS
Bibliographic Citation
Trauma (United Kingdom) Vol.24 No.1 (2022) , 72-76
Suggested Citation
Wannatoop T. Endovascular treatment of concomitant innominate and subclavian artery injury with pseudoaneurysms from a gunshot wound in a polytrauma patient. Trauma (United Kingdom) Vol.24 No.1 (2022) , 72-76. 76. doi:10.1177/14604086211016705 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/86772
Title
Endovascular treatment of concomitant innominate and subclavian artery injury with pseudoaneurysms from a gunshot wound in a polytrauma patient
Author(s)
Author's Affiliation
Other Contributor(s)
Abstract
Introduction: Injury of the innominate artery (IA) is associated with high mortality and morbidity, such as a major neurologic event. The aim of this case report was to describe an example of prioritization in polytrauma management by applying endovascular intervention in a difficult case with impending uncal herniation, extensive cerebral infarction, and large pseudoaneurysm from concomitant innominate and right subclavian artery injuries. Case Report: A 34-year-old woman sustained a gunshot wound to her upper chest that lodged in the anterior triangle of her neck and presented with tension pneumothorax and cardiac arrest, which was successfully resuscitated. Subsequently she developed drowsiness and left hemiparesis, and computerized tomography demonstrated a large right cerebral hemisphere and left cerebellar region infarction with impending uncal herniation and pseudoaneurysms from the IA and proximal right subclavian artery. After emergency craniectomy to avert herniation, endovascular treatment was performed to facilitate vessel repair due to anatomical difficulty and the patient’s unstable condition. She was discharged home 3 weeks after operation, and 2 months postoperatively, she was neurologically intact with no evidence of endoleakage or pseudoaneurysm. Conclusion: In such a complex polytrauma case, correct prioritization of interventions is crucial to obtaining the best outcomes, and the Endovascular Resuscitation and Trauma Management protocol can be applied as an alternative treatment protocol with good results.