Stent graft repair of subclavian and axillary vascular injuries: The Groote Schuur experience

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dc.contributor.authorNaidoo, N G
dc.contributor.authorNavsaria, P
dc.contributor.authorBeningfield, S J
dc.contributor.authorNatha, B
dc.contributor.authorCloete, N
dc.contributor.authorGill, H
dc.date.accessioned2021-10-08T07:17:47Z
dc.date.available2021-10-08T07:17:47Z
dc.date.issued2015
dc.description.abstractBACKGROUND: Trauma-related subclavian and axillary vascular injuries (SAVIs) are generally associated with high morbidity and mortality rates in the surgical literature. There is an emerging trend towards increasing use of stent grafts (covered stents) for repair, with evidence limited to small case series and case reports. OBJECTIVES: To report on the clinical and device-related outcomes of stent graft repair of trauma-related SAVIs at a single institution. METHODS: A retrospective chart review of all patients with trauma-related SAVIs requiring stent graft repair was performed. Outcome measures included technical success, mortality, amputation rate, device-related complications (early and late), and reintervention rates (early and late). RESULTS: A total of 31 patients was identified between June 2008 and October 2013 (30 males, 1 female). Mean age was 27.9 years (range 19-51). All 31 patients sustained a penetrating injury (93.5% stab, 6.5% gunshot injuries). There were 21 subclavian and 10 axillary artery injuries. Five patients (16%) were HIV-positive. Nine patients (29%) were shocked on presentation. Early results (30 days): There were no periprocedural deaths. Primary technical success was 83.9% (26/31). Five patients required adjunctive interventional or operative procedures. There were no early procedure-related complications, reinterventions or open conversions in this study. Overall, suboptimal results were seen in five patients (one type I endoleak and four type II endoleaks). Follow-up results (>30 days): Nineteen patients (61.3%) were available for follow-up. Mean duration of follow-up was 55.7 weeks (range 4 - 240). Overall stent graft patency was 89.5% (17/19). Four patients (21.1%) had an occluded stent graft. Stent graft salvage was possible in two patients. Three type II endoleaks were seen on follow-up. Late reinterventions were performed in five patients (26.3%). Conversion to an open procedure was not required in any patient. There was one late death and one major amputation of a stented limb in a patient who had sustained severe soft-tissue injuries during the follow-up period. CONCLUSION: Perioperative, early and intermediate results suggest that stent graft repair of select trauma-related SAVIs is relatively safe and effective. Axillary arteriovenous fistulas remain a particular challenge using this treatment modality. Larger prospective studies are required to define the utility of stent grafts for select trauma-related SAVIs better.
dc.identifier.apacitationNaidoo, N. G., Navsaria, P., Beningfield, S. J., Natha, B., Cloete, N., & Gill, H. (2015). Stent graft repair of subclavian and axillary vascular injuries: The Groote Schuur experience. <i>South African Journal of Surgery</i>, 53(1), 5 - 177. http://hdl.handle.net/11427/34820en_ZA
dc.identifier.chicagocitationNaidoo, N G, P Navsaria, S J Beningfield, B Natha, N Cloete, and H Gill "Stent graft repair of subclavian and axillary vascular injuries: The Groote Schuur experience." <i>South African Journal of Surgery</i> 53, 1. (2015): 5 - 177. http://hdl.handle.net/11427/34820en_ZA
dc.identifier.citationNaidoo, N.G., Navsaria, P., Beningfield, S.J., Natha, B., Cloete, N. & Gill, H. 2015. Stent graft repair of subclavian and axillary vascular injuries: The Groote Schuur experience. <i>South African Journal of Surgery.</i> 53(1):5 - 177. http://hdl.handle.net/11427/34820en_ZA
dc.identifier.issn0038-2361
dc.identifier.issn2078-5151
dc.identifier.ris TY - Journal Article AU - Naidoo, N G AU - Navsaria, P AU - Beningfield, S J AU - Natha, B AU - Cloete, N AU - Gill, H AB - BACKGROUND: Trauma-related subclavian and axillary vascular injuries (SAVIs) are generally associated with high morbidity and mortality rates in the surgical literature. There is an emerging trend towards increasing use of stent grafts (covered stents) for repair, with evidence limited to small case series and case reports. OBJECTIVES: To report on the clinical and device-related outcomes of stent graft repair of trauma-related SAVIs at a single institution. METHODS: A retrospective chart review of all patients with trauma-related SAVIs requiring stent graft repair was performed. Outcome measures included technical success, mortality, amputation rate, device-related complications (early and late), and reintervention rates (early and late). RESULTS: A total of 31 patients was identified between June 2008 and October 2013 (30 males, 1 female). Mean age was 27.9 years (range 19-51). All 31 patients sustained a penetrating injury (93.5% stab, 6.5% gunshot injuries). There were 21 subclavian and 10 axillary artery injuries. Five patients (16%) were HIV-positive. Nine patients (29%) were shocked on presentation. Early results (30 days): There were no periprocedural deaths. Primary technical success was 83.9% (26/31). Five patients required adjunctive interventional or operative procedures. There were no early procedure-related complications, reinterventions or open conversions in this study. Overall, suboptimal results were seen in five patients (one type I endoleak and four type II endoleaks). Follow-up results (>30 days): Nineteen patients (61.3%) were available for follow-up. Mean duration of follow-up was 55.7 weeks (range 4 - 240). Overall stent graft patency was 89.5% (17/19). Four patients (21.1%) had an occluded stent graft. Stent graft salvage was possible in two patients. Three type II endoleaks were seen on follow-up. Late reinterventions were performed in five patients (26.3%). Conversion to an open procedure was not required in any patient. There was one late death and one major amputation of a stented limb in a patient who had sustained severe soft-tissue injuries during the follow-up period. CONCLUSION: Perioperative, early and intermediate results suggest that stent graft repair of select trauma-related SAVIs is relatively safe and effective. Axillary arteriovenous fistulas remain a particular challenge using this treatment modality. Larger prospective studies are required to define the utility of stent grafts for select trauma-related SAVIs better. DA - 2015 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - South African Journal of Surgery LK - https://open.uct.ac.za PY - 2015 SM - 0038-2361 SM - 2078-5151 T1 - Stent graft repair of subclavian and axillary vascular injuries: The Groote Schuur experience TI - Stent graft repair of subclavian and axillary vascular injuries: The Groote Schuur experience UR - http://hdl.handle.net/11427/34820 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34820
dc.identifier.vancouvercitationNaidoo NG, Navsaria P, Beningfield SJ, Natha B, Cloete N, Gill H. Stent graft repair of subclavian and axillary vascular injuries: The Groote Schuur experience. South African Journal of Surgery. 2015;53(1):5 - 177. http://hdl.handle.net/11427/34820.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Surgery
dc.publisher.facultyFaculty of Health Sciences
dc.sourceSouth African Journal of Surgery
dc.source.journalissue1
dc.source.journalvolume53
dc.source.pagination5 - 177
dc.source.urihttps://dx.doi.org/10.7196/sajs.2368
dc.subject.otherAdult
dc.subject.otherAxillary Artery
dc.subject.otherBlood Vessel Prosthesis
dc.subject.otherBlood Vessel Prosthesis Implantation
dc.subject.otherFemale
dc.subject.otherHumans
dc.subject.otherMale
dc.subject.otherMiddle Aged
dc.subject.otherRetrospective Studies
dc.subject.otherSouth Africa
dc.subject.otherStents
dc.subject.otherSubclavian Artery
dc.subject.otherTreatment Outcome
dc.subject.otherVascular System Injuries
dc.subject.otherWounds, Penetrating
dc.subject.otherYoung Adult
dc.titleStent graft repair of subclavian and axillary vascular injuries: The Groote Schuur experience
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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