Case report: Endovascular embolization of the thoracoacromial branch of axillary artery after gunshot trauma at a regional trauma center

Boyoung Kim; Kejia Wang; Andrew Kiat; Gratian J Punch; Anthony S Leslie

doi:10.1016/j.ijscr.2022.107041

Case report: Endovascular embolization of the thoracoacromial branch of axillary artery after gunshot trauma at a regional trauma center

Int J Surg Case Rep. 2022 May:94:107041. doi: 10.1016/j.ijscr.2022.107041. Epub 2022 Apr 5.

Authors

Boyoung Kim¹, Kejia Wang², Andrew Kiat², Gratian J Punch³, Anthony S Leslie⁴

Affiliations

¹ Department of General Surgery, Lismore Base Hospital, Lismore, New South Wales 2480, Australia; Department of Vascular Surgery, Lismore Base Hospital, Lismore, New South Wales 2480, Australia. Electronic address: boyoungkim31@gmail.com.
² Department of General Surgery, Lismore Base Hospital, Lismore, New South Wales 2480, Australia; Department of Vascular Surgery, Lismore Base Hospital, Lismore, New South Wales 2480, Australia.
³ Department of General Surgery, Lismore Base Hospital, Lismore, New South Wales 2480, Australia.
⁴ Department of Vascular Surgery, Lismore Base Hospital, Lismore, New South Wales 2480, Australia.

Abstract

Introduction and importance: Penetrating subclavian-axillary artery injury is a rare vascular injury associated with high morbidity and mortality rates traditionally treated with open surgical repair, however endovascular treatments have been utilized in selected cases.

Case presentation: We report a case of a 31-year-old male with a traumatic gunshot injury to the thoracoacromial branch of the left axillary artery successfully managed with endovascular embolization at a regional trauma center.

Clinical discussion: The availability of a hybrid operating suite in severely injured patients is associated with reduced time to intervention, reduced operative duration and improved clinical outcomes. Our experience demonstrates the utility and benefit of a hybrid operating theatre in a regional trauma center. The availability of a hybrid suite allowed rapid diagnostic and therapeutic angiography with a minimally invasive approach and eliminated the need for urgent open surgical management. However, the high costs associated with a hybrid operating theatre remain the major barrier for most regional centers.

Conclusion: The availability of hybrid operating theatre at a regional trauma center allowed early diagnosis and successful management of the injury with a minimally invasive endovascular approach.

Keywords: Endovascular repair; Hybrid operating theatre; Penetrating trauma; RAPTOR suite; Regional trauma center; Subclavian-axillary artery injury.