Subclavian-axillary vascular trauma

Traumatic vascular injuries to the subclavian and axillary vessels are often associated with permanent neurologic impairment either by direct injury to the brachial plexus or by compression from an expanding hematoma. Prompt decompression of the plexus by evacuation of the hematoma may avoid permanent neurologic damage and decrease the morbidity of these injuries. We reviewed our experience with these injuries with particular reference to the effect of early decompression of the brachial plexus. From 1963 to 1984 we treated 40 patients. The causes of the injuries were penetrating trauma in 85% and blunt trauma in 15%. The results of arterial repair were excellent with only two failed repairs; neither resulted in severe ischemia. Two patients were suspected of having thrombosed venous repairs. Among the 12 patients with direct injury to the brachial plexus (partial or complete transection), only six had subsequent improvement of their neurologic dysfunction. In contrast, six of seven patients in whom there was only compression of the plexus by hematoma but no direct injury, had neurologic improvement following evacuation of the hematoma. This finding suggests that prompt decompression of the brachial plexus following these injuries may reduce the amount of neurologic impairment and reduce the morbidity of these injuries.