subclavian artery injury repair

The rupture of the aortic arch and its branches can occur in penetrating injuries and can also be seen in blunt trauma to the chest. The right innominate artery is most common in blunt trauma, and the blunt injury of the left common carotid artery is rare. Curing disease: Indication Once the diagnosis is established, it should be repaired immediately. Preoperative preparation Preoperative angiography can identify the rupture site and rationally select the surgical exploration of the incision and the path. Inferior subclavian artery injury, sometimes accompanied by other head and arm vascular injury, must be identified before surgery to prevent missed diagnosis or misdiagnosis. Surgical procedure 1. Incision: The right subclavian artery injury is suitable for the midline incision of the chest. The upper end of the incision can extend to the base of the neck. The left subclavian artery injury is generally selected from the third intercostal thoracotomy of the injured side, and a neck incision is added to the distal vessel to help reveal. 2. Retract the chest incision and explore the aortic arch and its branches. (1) Right subclavian artery injury repair: The right subclavian artery is exposed on the upper part of the left innominate artery bifurcation, and the adjacent vagus and recurrent laryngeal nerve are retracted and protected, and the finger pressure method is used to control bleeding. Free rupture of the proximal and distal vessels and juxtaposition of the closed clamp, after debridement, the application of the saphenous vein patch repair or direct suture. (2) repair of the left subclavian artery: the initial part of the injured lateral artery through the thoracic incision, wrapped around the obstruction band, the application of long non-invasive vascular clamp into the chest cavity to control proximal bleeding. Parallel and incision of the left neck of the clavicle, separation of the sternocleidomastoid muscle and anterior scalene muscle, if necessary, disconnect the clavicle to reveal the distal end of the subclavian artery. After dissociation, it is also blocked. After completely blocking and controlling the proximal and distal luminal hemorrhage of the subclavian artery, the local hematoma was incision and debridement treatment was performed. According to the condition of arterial injury, repair measures can be taken, which can be repaired by autologous saphenous vein or directly sutured.