Ten-Year Single-Centre Experience in Managing Traumatic Subclavian and Axillary Artery Injuries

Ten-Year Single-Centre Experience in Managing Traumatic Subclavian and Axillary Artery Injuries | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Ten-Year Single-Centre Experience in Managing Traumatic Subclavian and Axillary Artery Injuries Na Hyeon Lee, Seon Hee Kim, Seunghwan Song, Chung Won Lee, Hoon Kwon, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4411604/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Trauma-induced injuries to the subclavian and axillary arteries are rare. Treatment options include open repair and endovascular procedures, and the selection ofthe appropriate modality requires careful consideration. We aimed to evaluate the management of traumatic subclavian and axillary artery injuries at a single trauma center. Methods This single-center retrospective study analyzed the medical records of 12 patients who sustained injuries to the subclavian and axillary arteries between January 2013 and January 2023. Injury grading was categorized as follows: grade A, minimal injury (intima only); grade B, vessel laceration 50%; grade E, pseudoaneurysm; grade F, vessel transection; and grade G, occlusion. Patient outcomes, including in-hospital mortality, limb salvage and length of stay (LOS) in the hospital and intensive care unit (ICU), were identified. Results The mean age of the patients was 52.5±16.4 years, and 67% were males. The mean Injury Severity Score (ISS) was 22±4. The in-hospital mortality rate was 17% (n=2), and none of the patients required amputation. The median hospital LOS was 48 days (interquartile range [IQR], 22–71 days) and the median ICU LOS was 4 days (IQR, 2–22 days). When categorized into open repair, endovascular repair, and observation groups, a significant difference was observed in injury grade but not in ISS, LOS, or ICU LOS. Conclusion When managing patients with traumatic subclavian and axillary artery injuries, it is crucial to consider the patient's hemodynamic status and the degree of the injury. subclavian artery injury axillary artery injury trauma-induced injury endovascular repair Figures Figure 1 Introduction Traumatic injuries to the subclavian and axillary arteries are uncommon, accounting for only 5% of all vascular injuries. Optimal management of such injuries requires meticulous consideration of treatment options, including open repair and endovascular interventions [ 1 – 5 ]. Despite their low incidence, traumatic injuries require specialized attention because of their potential for substantial morbidity and mortality [ 4 – 5 ]. Deciding the therapeutic strategies requires an evaluation that balances the invasiveness of open repair and the availability of endovascular techniques [ 1 – 5 ]. Therefore, the treatment of traumatic subclavian and axillary artery injuries requires a judicious approach that considers the characteristics of each case [ 1 – 3 ]. Our study aimed to recommend a treatment protocol based on the degree of injury and hemodynamic status of patients with traumatic subclavian and axillary artery injuries. Materials and Methods Ethics Statement Informed consent was obtained from all participants or their legal guardians. All methods were according to relevant guidelines and regulations. This study was approved by our ethics committee. Study Design and Patient Characteristics A retrospective analysis of medical records was conducted to investigate traumatic injuries to the subclavian and axillary arteries at a Level I trauma center. The average patient volume at this institution is approximately 860 major trauma admissions a year. The study encompassed a 10-year period from January 2013 to January 2023. Twelve patients with diagnoses S25.1, “Injury of the innominate or subclavian artery” or S45.0, “Injury of the axillary artery” in their medical records were included in the analysis. Patient demographics, including age and sex, were also documented. Injury mechanisms were characterized as blunt or penetrating trauma. The Injury Severity Score (ISS), a measure of injury severity, was calculated for each patient. The occurrence of concomitant venous and brachial plexus injuries was also recorded. Injury Grading The degree of injury to the subclavian and axillary arteries was graded based on computed tomography (CT) angiography or intraoperative findings: grade A, minimal injury (intima only); grade B, vessel laceration 50%; grade E, pseudoaneurysm; grade F, vessel transection; and grade G, occlusion [ 1 ]. Patient Outcomes The primary outcomes were 30-day in-hospital mortality and limb salvage (amputation rate). The secondary outcomes were length of stay (LOS) in the hospital and intensive care unit (ICU). Treatment Approaches In our center, two factors were considered in the treatment strategy for subclavian and axillary artery injuries: the presence of hard or soft signs and the patient’s hemodynamic stability. Hard signs include: absent pulses, active hemorrhage, expanding hematoma, and distal ischemia. Soft signs include: decreased pulse, history of active bleeding, non-expanding hematoma, neurologic deficit, and proximity of the wound to the artery. Patients with hard signs and hemodynamic instability underwent immediate open repair, and CT angiography was performed in stable patients. In constrast patients who were hemodynamically unstable and had soft signs were resuscitated according to the Advanced Trauma Life Support guidelines. Once the patients were resuscitated, CT angiography was performed to assess the injury and determine the need for further intervention. A retrospective analysis revealed that patients classified as grades A, B, or C underwent observation; those classified as grades D or E consulted interventional radiologists and vascular specialists to determine the appropriate course of action, endovascular techniques or open repair; and those classified as grades F or G underwent open repair (Fig. 1 ). Statistical Analyses In our analysis, summary statistics are presented as median and interquartile range or mean with standard deviation. Categorical variables are expressed as counts and percentages. Chi-square test and Fisher’s exact test were performed to compare the frequencies of categorical variables between the groups. The Mann–Whitney U-test and Wilcoxon rank-sum test were performed to compare the mean values of continuous variables. The Analysis of Variance test was used to assess the differences between the three groups. Statistical significance was set at a p-value of < .05. SPSS (version 22.0; IBM Corp., Armonk, NY, USA) was used to analyze the data. Results Patient and Injury Characteristics This study included 12 patients with traumatic subclavian and axillary arterial injuries. The mean age was 52.5 ± 16.4 years, and 67% were male. The mean systolic blood pressure among the patients was 83 ± 40 mmHg, and the mean Glasgow Coma Scale score was 12 ± 4. The mean ISS was 22 ± 4. In addition, the average abbreviated injury scale (AIS) was as follows : AIS of the head and neck was confirmed as 2, face 2, chest 4, abdomen 2, extremity 2, and external 1. Injuries were distributed as follows: axillary artery, 42%; subclavian artery, 50%; and both arteries, 8%. Regarding the mechanism of injury, 75% of the patients experienced blunt trauma, whereas 25% had penetrating injuries. The distribution according to injury grade was as follows: grade A, 0%; grade B, 8.3%; grade C, 8.3%; grade D, 8.3%; grade E, 25%; grade F, 17%; and grade G, 33%. Vein and brachial plexus injuries were present in 25% and 75% of the patients, respectively. Patient distribution according to treatment modalities Treatment modalities included open repair, endovascular repair, and observation. Seven patients underwent open repair, three underwent endovascular repair, and two underwent observation. Although differences in ISS were noted between the treatment groups, the differences did not reach statistical significance (p = .077). No significant difference in the mechanism of injury was observed between the treatment groups (p = .240). However, there were significant differences in the distribution of injury grades. The observation group included 1 patient each in grades B and C; the endovascular repair group included 1 patient in grade D and 2 patients in grade E; and the open repair group included 1 patient in grade E, 2 patients in grade F, and 4 patients in grade G (p < .001). Patient outcomes The rate of in-hospital mortality within 30 days was 17% (n = 2). One patient died of pneumonia and the other died of massive bleeding attributed to severe lung injury. None of the patients required amputation (Table 1 ). In one patient who underwent open repair, the distal pulse was maintained after bypass surgery. However, 9 days after surgery, the distal pulse disappeared; therefore a CT scan was performed, and thrombectomy was performed because no flow was observed below the brachial artery. Subsequently, no re-intervention was required, and the distal flow was intact on CT. The flow was also intact on follow-up CT performed afterwards. In other patients, no complications requiring arterial reintervention were identified on follow-up CT scans. Table 1 Clinical characteristics and management outcomes of traumatic subclavian and axillary artery injuries. Variables Overall Open repair Endovascular repair Observation p-value (n = 12) (n = 7) (n = 3) (n = 2) Age (years) 52.5 ± 16.4 46.6 ± 18.0 65.7 ± 10.8 53.5 ± 3.5 .258 Sex .852 Female 4 (33) 2 (50) 1 (25) 1 (25) Male 8 (67) 5 (63) 2 (25) 1 (12) Systolic blood pressure (mmHg) 83 ± 40 70 ± 41 100 ± 10 105 ± 64 .417 Glasgow Coma Scale Score 12 ± 4 14 ± 2 12 ± 6 8 ± 1 .156 Injury Severity Score 22 ± 4 23 ± 4 18 ± 2 27 ± 4 .077 Mechanism of injury .240 Blunt 9 (75) 4 (45) 3 (33) 2 (22) Penetrating 3 (25) 3 (100) Artery type .519 Axillary 5 (42) 3 (60) 2 (40) Subclavian 6 (50) 3 (50) 1 (17) 2 (33) Both 1 (8) 1 (100) Injury grade .000 A: Minimal injury (intima only) 0 B: 50% vessel circumference laceration 1 (8.3) 1 (100) E: Pseudoaneurysm 3 (25) 1 (33) 2 (67) F: Vessel transection 2 (17) 2 (100) G: Occlusion 4 (33) 4 (100) Vein injuries 3 (25) 3 (100) .240 Brachial plexus injury 9 (75) 7 (78) 1 (11) 1 (11) .114 Reintervention 1 (8) 1 (100) Amputation 0 (0) Length of hospital stay (days) 48 [22−71] 49 [43−60] 22 [22−52] 102 [51−152] .100 Intensive care unit length of stay (days) 4 [2−22] 3 [2−15] 11 [7−16] 24 [12−35] .575 In-hospital 30-day mortality 2 (17) 0 (0) 1 (50) 1 (50) .165 Values are presented as mean ± standard deviation, n (%), or median (interquartile range). The median hospital LOS was 48 days (interquartile range [IQR], 22–71 days), and the median ICU LOS was 4 days (IQR, 2–22 days). Although differences in hospital and ICU LOS were noted between the treatment groups, the differences were not statistically significant (p = .100 and p = .575, respectively) (Table 1 ). Characteristics of Open Repair and Postoperative Antithrombotic Management Various surgical procedures have been used to manage traumatic subclavian and axillary arterial injuries. Bypass procedures were the most common, with six patients receiving a great saphenous vein graft (n = 4) or a prosthetic graft (n = 2). Primary repair was performed in one patient. The infraclavicular approach was commonly used to access the injured arteries (n = 5), followed by the supraclavicular approach (n = 1). A trapdoor incision was used in one patient. Postoperative anticoagulant or antiplatelet therapy was administered to seven patients to prevent thrombotic complications. Among these, four patients received aspirin, one received clopidogrel, one received a combination of aspirin and clopidogrel, and one was treated with direct oral anticoagulants (Table 2 ). Table 2 Surgical characteristics and postoperative antithrombotic management Open repair (n = 7) Operation type Bypass 6 Great saphenous vein 4 Prosthetic graft 2 Primary repair 1 Incision Supraclavicular 1 Infraclavicular 5 Trapdoor 1 Postoperative anticoagulant or antiplatelet therapy 7 Aspirin 4 Clopidogrel 1 Aspirin + Clopidogrel 1 Direct oral anticoagulants 1 Discussion This retrospective evaluation of traumatic artery injuries provides a platform for the management and outcomes of uncommon yet critical vascular traumas. The rarity of such injuries underscores the challenges of selecting appropriate treatment modalities and balancing invasiveness and efficacy [ 1 – 7 ]. Therefore, through our research, we would like to share our experience in evaluating and treating traumatic artery injuries and provide a protocol. When a patient with suspected traumatic subclavian or axillary artery injuries visits the hospital, we recommend checking whether the patient has hard or soft signs and hemodynamic instability. For hemodynamically stable patients, CT angiography can be performed to evaluate vessel injuries. For hemodynamically unstable patients, immediate open repair should be commenced when there is a hard sign and CT angiography should be performed after resuscitation when there is a soft sign. Depending on the injury grade on CT, 50% or less laceration may be observed. In cases of laceration exceeding 50% or pseudoaneurysm, open or endovascular repair can be performed based on the availability at each center. Open repair is recommended for high-grade injuries such as transection and occlusion. Although the sample size of our study was small, we observed occlusion or stenosis in all patients who underwent observation for lacerations ruling out the requirement for reintervention or amputation. Importantly, none of the patients required amputation due to limb ischemia, and follow-up CT showed no intravascular occlusion, confirming the effectiveness of the treatment strategy. Injury severity grading, denoted by grade, is a crucial factor in treatment decisions. The statistically significant association between injury grade and choice of open repair or endovascular intervention highlights the influence of injury complexity on therapeutic selection. This correlation indicated that higher injury grades, warranting greater intervention complexity, prompted a preference for open repair. This aligns with the principles of achieving optimal outcomes while minimizing the risks of endovascular interventions. The findings of this study reinforce the vital role of endovascular techniques, particularly in treating pseudoaneurysms. The effective use of covered stents demonstrates advancements in endovascular technology and its applicability in managing specific vascular complications. The choice between open repair and endovascular intervention, as reflected in our results, underscores the importance of individualized patient assessment and shared decision-making among a multidisciplinary team. Therefore, collaboration and multidisciplinary approaches between trauma surgeons, vascular specialists, and interventionalists are important. Hospital and ICU LOS were the longest in the observation group, although the difference was not statistically significant. Considering ISS, it is believed that the treatment period was long because injuries to organs other than the subclavian and axillary arteries were severe. Assessment of the operation type, incision, and postoperative therapy provided insights into the various approaches to managing these injuries. Notably, bypass procedures using the great saphenous vein or artificial grafts were common (n = 6), reflecting the complexity of these cases. The postoperative use of antiplatelet and anticoagulant therapies further exemplifies the multidisciplinary strategies used to prevent thrombotic complications [ 1 , 3 , 6 , 8 ]. Acknowledging the inherent limitations of our investigation, primarily its retrospective nature and single-center framework, is crucial. Our study yields valuable insights into our institution’s specific approach to traumatic subclavian and axillary artery injuries; however, the applicability of our findings on a broader scale warrants further exploration through multicenter collaborations. Consequently, there is a compelling need for further multicenter studies to amass a more extensive and diverse patient cohort with traumatic subclavian and axillary artery injuries. This approach would facilitate the understanding of the management strategies and outcomes associated with these injuries across various healthcare settings. Furthermore, comparative studies are imperative to assess the long-term consequences and cost-effectiveness of alternative treatment modalities, particularly open repair versus endovascular repair, in the management of traumatic subclavian and axillary artery injuries. In these comparative investigations, it is paramount to scrutinize pertinent variables, including the incidence of reinterventions, occurrence of complications, and judicious allocation of resources. Furthermore, the development of predictive models or scoring systems, grounded in empirical data, has the potential to furnish clinicians with valuable tools for making well-informed decisions regarding the selection of treatment modalities. Such models could be tailored to account for patient-specific characteristics, injury severity, and other pertinent factors, thereby contributing to optimized patient care and therapeutic outcomes. In conclusion, our analysis of the management of traumatic subclavian and axillary artery injuries, based on our single-center experience, adds valuable insights to the discourse surrounding these rare yet intricate vascular traumas. The findings affirm the importance of considering injury grade, patient characteristics, and available technologies when choosing between open repair and endovascular interventions. Despite the absence of significant differences in some aspects across the treatment groups, this study underscores the importance of individualized care plans. This highlights the need for further research to establish standardized protocols for optimal patient outcomes. Declarations Competing Interests The author(s) declare no competing interests Author Contribution Conceptualization: Na Hyeon Lee; Methodology: Seunghwan Song, Chung Won Lee; Validation: Sang Bong Lee, Chan Ik Park; Formal analysis: Sun Hyun Kim, Hohyun Kim; Investigation: Hoon Kwon; Resources: Dong Yeon Ryu; Data Curation: Gil Hwan Kim; Writing (Original Draft): Na Hyeon Lee; Writing (Review & Editing): Na Hyeon Lee; Visualization: Hoon Kwon; Supervision: Seon Hee Kim, Project administration: Jae Hun Kim Acknowledgement This work was supported by clinical research grant from Pusan National University Hospital in 2024. Data Availability The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. References Waller CJ, Cogbill TH, Kallies KJ, Ramirez LD, Cardenas JM, Todd, et al. Contemporary management of subclavian and axillary artery injuries—a Western Trauma Association multicenter review. J Trauma Acute Care Surg. 2017;83:1023–31. https://doi.org/10.1097/TA.0000000000001645 . Castelli P, Caronno R, Piffaretti G, Tozzi M, Lagana D, Carrafiello, et al. Endovascular repair of traumatic injuries of the subclavian and axillary arteries. Injury. 2005;36:778–82. https://doi.org/10.1016/j.injury.2004.12.046 . Aksoy M, Tunca F, Yanar H, Guloglu R, Ertekin C, Kurtoglu M. Traumatic injuries to the subclavian and axillary arteries: a 13-year review. Surg Today. 2005;35:561–5. https://doi.org/10.1007/s00595-005-2990-y . Jinadasa SP, Stoner JF, DuBose JJ, Kundi R, Scalea TM, Morrison JJ. Endovascular management of axillosubclavian artery injuries. J Trauma Acute Care Surg. 2022;92:e28–34. https://doi.org/10.1097/TA.0000000000003439 . Branco BC, Boutrous ML, DuBose JJ, Leake SS, Charlton-Ouw K, Rhee P, et al. Outcome comparison between open and endovascular management of axillosubclavian arterial injuries. J Vasc Surg. 2016;63:702–9. https://doi.org/10.1016/j.jvs.2015.08.117 . Tadayon N, Yavari N, Zarrintan S, Hosseini SM, Kalantar-Motamedi SMR. Management of traumatic subclavian artery injuries in a high-volume vascular surgery centre in Iran. J Cardiovasc Thorac Res. 2020;12:145–9. https://doi.org/10.34172/jcvtr.2020.24 . Torres IO, de Andrade RCL, Apoloni R, da Silva ES, Puech-Leão P, De Luccia N. In hospital and long term outcomes after repair of subclavian and axillary arterial injuries. Eur J Vasc Endovasc Surg. 2023;66:840–7. https://doi.org/10.1016/j.ejvs.2023.08.008 . Zhang J, Basu R, Bauder AR, Quatramoni JG, Glaser J, Kalapatapu V, et al. Endovascular repair of traumatic axillosubclavian artery injuries. J Vasc Surg Cases Innov Tech. 2022;8:23–7. https://doi.org/10.1016/j.jvscit.2021.11.006 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4411604","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":305601891,"identity":"ce9d7934-4a4f-4f18-9700-f433c2659e09","order_by":0,"name":"Na Hyeon Lee","email":"","orcid":"","institution":"Pusan National University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Na","middleName":"Hyeon","lastName":"Lee","suffix":""},{"id":305601892,"identity":"6a26cb46-78fc-4ccf-a72d-40cf474ac4ec","order_by":1,"name":"Seon Hee 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08:06:57","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4411604/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4411604/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57430547,"identity":"9ca26250-a5a6-4b38-8948-a2c77a276169","added_by":"auto","created_at":"2024-05-30 14:54:31","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":581276,"visible":true,"origin":"","legend":"\u003cp\u003eTreatment strategies and approach algorithms for patients with subclavian and axillary artery injuries\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4411604/v1/66a70c7d8969077ec383556c.jpg"},{"id":60256328,"identity":"80706fb6-e24f-4727-a884-91da77119244","added_by":"auto","created_at":"2024-07-14 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Optimal management of such injuries requires meticulous consideration of treatment options, including open repair and endovascular interventions [\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Despite their low incidence, traumatic injuries require specialized attention because of their potential for substantial morbidity and mortality [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Deciding the therapeutic strategies requires an evaluation that balances the invasiveness of open repair and the availability of endovascular techniques [\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Therefore, the treatment of traumatic subclavian and axillary artery injuries requires a judicious approach that considers the characteristics of each case [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Our study aimed to recommend a treatment protocol based on the degree of injury and hemodynamic status of patients with traumatic subclavian and axillary artery injuries.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEthics Statement\u003c/h2\u003e \u003cp\u003eInformed consent was obtained from all participants or their legal guardians. All methods were according to relevant guidelines and regulations. This study was approved by our ethics committee.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Patient Characteristics\u003c/h2\u003e \u003cp\u003eA retrospective analysis of medical records was conducted to investigate traumatic injuries to the subclavian and axillary arteries at a Level I trauma center. The average patient volume at this institution is approximately 860 major trauma admissions a year. The study encompassed a 10-year period from January 2013 to January 2023. Twelve patients with diagnoses S25.1, \u0026ldquo;Injury of the innominate or subclavian artery\u0026rdquo; or S45.0, \u0026ldquo;Injury of the axillary artery\u0026rdquo; in their medical records were included in the analysis. Patient demographics, including age and sex, were also documented. Injury mechanisms were characterized as blunt or penetrating trauma. The Injury Severity Score (ISS), a measure of injury severity, was calculated for each patient. The occurrence of concomitant venous and brachial plexus injuries was also recorded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eInjury Grading\u003c/h2\u003e \u003cp\u003eThe degree of injury to the subclavian and axillary arteries was graded based on computed tomography (CT) angiography or intraoperative findings: grade A, minimal injury (intima only); grade B, vessel laceration\u0026thinsp;\u0026lt;\u0026thinsp;25%; grade C, laceration 25\u0026ndash;50%; grade D, laceration\u0026thinsp;\u0026gt;\u0026thinsp;50%; grade E, pseudoaneurysm; grade F, vessel transection; and grade G, occlusion [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePatient Outcomes\u003c/h2\u003e \u003cp\u003eThe primary outcomes were 30-day in-hospital mortality and limb salvage (amputation rate). The secondary outcomes were length of stay (LOS) in the hospital and intensive care unit (ICU).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eTreatment Approaches\u003c/h2\u003e \u003cp\u003eIn our center, two factors were considered in the treatment strategy for subclavian and axillary artery injuries: the presence of hard or soft signs and the patient\u0026rsquo;s hemodynamic stability. Hard signs include: absent pulses, active hemorrhage, expanding hematoma, and distal ischemia. Soft signs include: decreased pulse, history of active bleeding, non-expanding hematoma, neurologic deficit, and proximity of the wound to the artery. Patients with hard signs and hemodynamic instability underwent immediate open repair, and CT angiography was performed in stable patients. In constrast patients who were hemodynamically unstable and had soft signs were resuscitated according to the Advanced Trauma Life Support guidelines. Once the patients were resuscitated, CT angiography was performed to assess the injury and determine the need for further intervention. A retrospective analysis revealed that patients classified as grades A, B, or C underwent observation; those classified as grades D or E consulted interventional radiologists and vascular specialists to determine the appropriate course of action, endovascular techniques or open repair; and those classified as grades F or G underwent open repair (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analyses\u003c/h2\u003e \u003cp\u003eIn our analysis, summary statistics are presented as median and interquartile range or mean with standard deviation. Categorical variables are expressed as counts and percentages. Chi-square test and Fisher\u0026rsquo;s exact test were performed to compare the frequencies of categorical variables between the groups. The Mann\u0026ndash;Whitney U-test and Wilcoxon rank-sum test were performed to compare the mean values of continuous variables. The Analysis of Variance test was used to assess the differences between the three groups. Statistical significance was set at a p-value of \u0026lt;\u0026thinsp;.05. SPSS (version 22.0; IBM Corp., Armonk, NY, USA) was used to analyze the data.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePatient and Injury Characteristics\u003c/h2\u003e \u003cp\u003eThis study included 12 patients with traumatic subclavian and axillary arterial injuries. The mean age was 52.5\u0026thinsp;\u0026plusmn;\u0026thinsp;16.4 years, and 67% were male. The mean systolic blood pressure among the patients was 83\u0026thinsp;\u0026plusmn;\u0026thinsp;40 mmHg, and the mean Glasgow Coma Scale score was 12\u0026thinsp;\u0026plusmn;\u0026thinsp;4. The mean ISS was 22\u0026thinsp;\u0026plusmn;\u0026thinsp;4. In addition, the average abbreviated injury scale (AIS) was as follows : AIS of the head and neck was confirmed as 2, face 2, chest 4, abdomen 2, extremity 2, and external 1.\u003c/p\u003e \u003cp\u003eInjuries were distributed as follows: axillary artery, 42%; subclavian artery, 50%; and both arteries, 8%. Regarding the mechanism of injury, 75% of the patients experienced blunt trauma, whereas 25% had penetrating injuries. The distribution according to injury grade was as follows: grade A, 0%; grade B, 8.3%; grade C, 8.3%; grade D, 8.3%; grade E, 25%; grade F, 17%; and grade G, 33%. Vein and brachial plexus injuries were present in 25% and 75% of the patients, respectively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePatient distribution according to treatment modalities\u003c/h2\u003e \u003cp\u003eTreatment modalities included open repair, endovascular repair, and observation. Seven patients underwent open repair, three underwent endovascular repair, and two underwent observation. Although differences in ISS were noted between the treatment groups, the differences did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;.077). No significant difference in the mechanism of injury was observed between the treatment groups (p\u0026thinsp;=\u0026thinsp;.240). However, there were significant differences in the distribution of injury grades. The observation group included 1 patient each in grades B and C; the endovascular repair group included 1 patient in grade D and 2 patients in grade E; and the open repair group included 1 patient in grade E, 2 patients in grade F, and 4 patients in grade G (p\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePatient outcomes\u003c/h2\u003e \u003cp\u003eThe rate of in-hospital mortality within 30 days was 17% (n\u0026thinsp;=\u0026thinsp;2). One patient died of pneumonia and the other died of massive bleeding attributed to severe lung injury. None of the patients required amputation (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In one patient who underwent open repair, the distal pulse was maintained after bypass surgery. However, 9 days after surgery, the distal pulse disappeared; therefore a CT scan was performed, and thrombectomy was performed because no flow was observed below the brachial artery. Subsequently, no re-intervention was required, and the distal flow was intact on CT. The flow was also intact on follow-up CT performed afterwards. In other patients, no complications requiring arterial reintervention were identified on follow-up CT scans.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics and management outcomes of traumatic subclavian and axillary artery injuries.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOpen repair\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEndovascular repair\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eObservation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.5\u0026thinsp;\u0026plusmn;\u0026thinsp;16.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.6\u0026thinsp;\u0026plusmn;\u0026thinsp;18.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.7\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.258\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.852\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSystolic blood pressure (mmHg)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83\u0026thinsp;\u0026plusmn;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70\u0026thinsp;\u0026plusmn;\u0026thinsp;41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e105\u0026thinsp;\u0026plusmn;\u0026thinsp;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.417\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGlasgow Coma Scale Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.156\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInjury Severity Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMechanism of injury\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.240\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlunt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePenetrating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eArtery type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.519\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAxillary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubclavian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInjury grade\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA: Minimal injury (intima only)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB: \u0026lt;25% vessel circumference laceration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC: 25\u0026ndash;50% vessel circumference laceration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD: \u0026gt;50% vessel circumference laceration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE: Pseudoaneurysm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF: Vessel transection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG: Occlusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVein injuries\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.240\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBrachial plexus injury\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.114\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReintervention\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAmputation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLength of hospital stay (days)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 [22\u0026minus;71]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 [43\u0026minus;60]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 [22\u0026minus;52]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e102 [51\u0026minus;152]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntensive care unit length of stay (days)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 [2\u0026minus;22]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 [2\u0026minus;15]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 [7\u0026minus;16]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24 [12\u0026minus;35]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.575\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIn-hospital 30-day mortality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.165\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eValues are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, n (%), or median (interquartile range).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe median hospital LOS was 48 days (interquartile range [IQR], 22\u0026ndash;71 days), and the median ICU LOS was 4 days (IQR, 2\u0026ndash;22 days). Although differences in hospital and ICU LOS were noted between the treatment groups, the differences were not statistically significant (p\u0026thinsp;=\u0026thinsp;.100 and p\u0026thinsp;=\u0026thinsp;.575, respectively) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). \u003cb\u003eCharacteristics of Open Repair and Postoperative Antithrombotic Management\u003c/b\u003e\u003c/p\u003e \u003cp\u003eVarious surgical procedures have been used to manage traumatic subclavian and axillary arterial injuries. Bypass procedures were the most common, with six patients receiving a great saphenous vein graft (n\u0026thinsp;=\u0026thinsp;4) or a prosthetic graft (n\u0026thinsp;=\u0026thinsp;2). Primary repair was performed in one patient.\u003c/p\u003e \u003cp\u003eThe infraclavicular approach was commonly used to access the injured arteries (n\u0026thinsp;=\u0026thinsp;5), followed by the supraclavicular approach (n\u0026thinsp;=\u0026thinsp;1). A trapdoor incision was used in one patient.\u003c/p\u003e \u003cp\u003ePostoperative anticoagulant or antiplatelet therapy was administered to seven patients to prevent thrombotic complications. Among these, four patients received aspirin, one received clopidogrel, one received a combination of aspirin and clopidogrel, and one was treated with direct oral anticoagulants (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSurgical characteristics and postoperative antithrombotic management\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOpen repair\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBypass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGreat saphenous vein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProsthetic graft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary repair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIncision\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupraclavicular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfraclavicular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrapdoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative anticoagulant or antiplatelet therapy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAspirin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClopidogrel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAspirin\u0026thinsp;+\u0026thinsp;Clopidogrel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect oral anticoagulants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis retrospective evaluation of traumatic artery injuries provides a platform for the management and outcomes of uncommon yet critical vascular traumas. The rarity of such injuries underscores the challenges of selecting appropriate treatment modalities and balancing invasiveness and efficacy [\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Therefore, through our research, we would like to share our experience in evaluating and treating traumatic artery injuries and provide a protocol.\u003c/p\u003e \u003cp\u003eWhen a patient with suspected traumatic subclavian or axillary artery injuries visits the hospital, we recommend checking whether the patient has hard or soft signs and hemodynamic instability. For hemodynamically stable patients, CT angiography can be performed to evaluate vessel injuries. For hemodynamically unstable patients, immediate open repair should be commenced when there is a hard sign and CT angiography should be performed after resuscitation when there is a soft sign. Depending on the injury grade on CT, 50% or less laceration may be observed. In cases of laceration exceeding 50% or pseudoaneurysm, open or endovascular repair can be performed based on the availability at each center. Open repair is recommended for high-grade injuries such as transection and occlusion.\u003c/p\u003e \u003cp\u003eAlthough the sample size of our study was small, we observed occlusion or stenosis in all patients who underwent observation for lacerations ruling out the requirement for reintervention or amputation. Importantly, none of the patients required amputation due to limb ischemia, and follow-up CT showed no intravascular occlusion, confirming the effectiveness of the treatment strategy. Injury severity grading, denoted by grade, is a crucial factor in treatment decisions. The statistically significant association between injury grade and choice of open repair or endovascular intervention highlights the influence of injury complexity on therapeutic selection. This correlation indicated that higher injury grades, warranting greater intervention complexity, prompted a preference for open repair. This aligns with the principles of achieving optimal outcomes while minimizing the risks of endovascular interventions.\u003c/p\u003e \u003cp\u003eThe findings of this study reinforce the vital role of endovascular techniques, particularly in treating pseudoaneurysms. The effective use of covered stents demonstrates advancements in endovascular technology and its applicability in managing specific vascular complications. The choice between open repair and endovascular intervention, as reflected in our results, underscores the importance of individualized patient assessment and shared decision-making among a multidisciplinary team. Therefore, collaboration and multidisciplinary approaches between trauma surgeons, vascular specialists, and interventionalists are important.\u003c/p\u003e \u003cp\u003eHospital and ICU LOS were the longest in the observation group, although the difference was not statistically significant. Considering ISS, it is believed that the treatment period was long because injuries to organs other than the subclavian and axillary arteries were severe.\u003c/p\u003e \u003cp\u003eAssessment of the operation type, incision, and postoperative therapy provided insights into the various approaches to managing these injuries. Notably, bypass procedures using the great saphenous vein or artificial grafts were common (n\u0026thinsp;=\u0026thinsp;6), reflecting the complexity of these cases. The postoperative use of antiplatelet and anticoagulant therapies further exemplifies the multidisciplinary strategies used to prevent thrombotic complications [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAcknowledging the inherent limitations of our investigation, primarily its retrospective nature and single-center framework, is crucial. Our study yields valuable insights into our institution\u0026rsquo;s specific approach to traumatic subclavian and axillary artery injuries; however, the applicability of our findings on a broader scale warrants further exploration through multicenter collaborations. Consequently, there is a compelling need for further multicenter studies to amass a more extensive and diverse patient cohort with traumatic subclavian and axillary artery injuries. This approach would facilitate the understanding of the management strategies and outcomes associated with these injuries across various healthcare settings.\u003c/p\u003e \u003cp\u003eFurthermore, comparative studies are imperative to assess the long-term consequences and cost-effectiveness of alternative treatment modalities, particularly open repair versus endovascular repair, in the management of traumatic subclavian and axillary artery injuries. In these comparative investigations, it is paramount to scrutinize pertinent variables, including the incidence of reinterventions, occurrence of complications, and judicious allocation of resources. Furthermore, the development of predictive models or scoring systems, grounded in empirical data, has the potential to furnish clinicians with valuable tools for making well-informed decisions regarding the selection of treatment modalities. Such models could be tailored to account for patient-specific characteristics, injury severity, and other pertinent factors, thereby contributing to optimized patient care and therapeutic outcomes.\u003c/p\u003e \u003cp\u003eIn conclusion, our analysis of the management of traumatic subclavian and axillary artery injuries, based on our single-center experience, adds valuable insights to the discourse surrounding these rare yet intricate vascular traumas. The findings affirm the importance of considering injury grade, patient characteristics, and available technologies when choosing between open repair and endovascular interventions. Despite the absence of significant differences in some aspects across the treatment groups, this study underscores the importance of individualized care plans. This highlights the need for further research to establish standardized protocols for optimal patient outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003eThe author(s) declare no competing interests\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization: Na Hyeon Lee; Methodology: Seunghwan Song, Chung Won Lee; Validation: Sang Bong Lee, Chan Ik Park; Formal analysis: Sun Hyun Kim, Hohyun Kim; Investigation: Hoon Kwon; Resources: Dong Yeon Ryu; Data Curation: Gil Hwan Kim; Writing (Original Draft): Na Hyeon Lee; Writing (Review \u0026amp; Editing): Na Hyeon Lee; Visualization: Hoon Kwon; Supervision: Seon Hee Kim, Project administration: Jae Hun Kim\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThis work was supported by clinical research grant from Pusan National University Hospital in 2024.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWaller CJ, Cogbill TH, Kallies KJ, Ramirez LD, Cardenas JM, Todd, et al. Contemporary management of subclavian and axillary artery injuries\u0026mdash;a Western Trauma Association multicenter review. J Trauma Acute Care Surg. 2017;83:1023\u0026ndash;31. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/TA.0000000000001645\u003c/span\u003e\u003cspan address=\"10.1097/TA.0000000000001645\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCastelli P, Caronno R, Piffaretti G, Tozzi M, Lagana D, Carrafiello, et al. Endovascular repair of traumatic injuries of the subclavian and axillary arteries. Injury. 2005;36:778\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.injury.2004.12.046\u003c/span\u003e\u003cspan address=\"10.1016/j.injury.2004.12.046\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAksoy M, Tunca F, Yanar H, Guloglu R, Ertekin C, Kurtoglu M. Traumatic injuries to the subclavian and axillary arteries: a 13-year review. Surg Today. 2005;35:561\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00595-005-2990-y\u003c/span\u003e\u003cspan address=\"10.1007/s00595-005-2990-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJinadasa SP, Stoner JF, DuBose JJ, Kundi R, Scalea TM, Morrison JJ. Endovascular management of axillosubclavian artery injuries. J Trauma Acute Care Surg. 2022;92:e28\u0026ndash;34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/TA.0000000000003439\u003c/span\u003e\u003cspan address=\"10.1097/TA.0000000000003439\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBranco BC, Boutrous ML, DuBose JJ, Leake SS, Charlton-Ouw K, Rhee P, et al. Outcome comparison between open and endovascular management of axillosubclavian arterial injuries. J Vasc Surg. 2016;63:702\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jvs.2015.08.117\u003c/span\u003e\u003cspan address=\"10.1016/j.jvs.2015.08.117\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTadayon N, Yavari N, Zarrintan S, Hosseini SM, Kalantar-Motamedi SMR. Management of traumatic subclavian artery injuries in a high-volume vascular surgery centre in Iran. J Cardiovasc Thorac Res. 2020;12:145\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.34172/jcvtr.2020.24\u003c/span\u003e\u003cspan address=\"10.34172/jcvtr.2020.24\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTorres IO, de Andrade RCL, Apoloni R, da Silva ES, Puech-Le\u0026atilde;o P, De Luccia N. In hospital and long term outcomes after repair of subclavian and axillary arterial injuries. Eur J Vasc Endovasc Surg. 2023;66:840\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ejvs.2023.08.008\u003c/span\u003e\u003cspan address=\"10.1016/j.ejvs.2023.08.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang J, Basu R, Bauder AR, Quatramoni JG, Glaser J, Kalapatapu V, et al. Endovascular repair of traumatic axillosubclavian artery injuries. J Vasc Surg Cases Innov Tech. 2022;8:23\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jvscit.2021.11.006\u003c/span\u003e\u003cspan address=\"10.1016/j.jvscit.2021.11.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"subclavian artery injury, axillary artery injury, trauma-induced injury, endovascular repair","lastPublishedDoi":"10.21203/rs.3.rs-4411604/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4411604/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTrauma-induced injuries to the subclavian and axillary arteries are rare. Treatment options include open repair and endovascular procedures, and the selection ofthe appropriate modality requires careful consideration. We aimed to evaluate the management of traumatic subclavian and axillary artery injuries at a single trauma center.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis single-center retrospective study analyzed the medical records of 12 patients who sustained injuries to the subclavian and axillary arteries between January 2013 and January 2023. Injury grading was categorized as follows: grade A, minimal injury (intima only); grade B, vessel laceration \u0026lt;25%; grade C, laceration 25–50%; grade D, laceration \u0026gt;50%; grade E, pseudoaneurysm; grade F, vessel transection; and grade G, occlusion. Patient outcomes, including in-hospital mortality, limb salvage and length of stay (LOS) in the hospital and intensive care unit (ICU), were identified.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean age of the patients was 52.5±16.4 years, and 67% were males. The mean Injury Severity Score (ISS) was 22±4. The in-hospital mortality rate was 17% (n=2), and none of the patients required amputation. The median hospital LOS was 48 days (interquartile range [IQR], 22–71 days) and the median ICU LOS was 4 days (IQR, 2–22 days). When categorized into open repair, endovascular repair, and observation groups, a significant difference was observed in injury grade but not in ISS, LOS, or ICU LOS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen managing patients with traumatic subclavian and axillary artery injuries, it is crucial to consider the patient's hemodynamic status and the degree of the injury.\u003c/p\u003e","manuscriptTitle":"Ten-Year Single-Centre Experience in Managing Traumatic Subclavian and Axillary Artery Injuries","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-30 14:54:27","doi":"10.21203/rs.3.rs-4411604/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d4474594-7eeb-4852-9ec3-d4c4c43e013e","owner":[],"postedDate":"May 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-17T08:27:57+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-30 14:54:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4411604","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4411604","identity":"rs-4411604","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}