%0 Journal Article
%T Isolated Subclavian Vein Injury: A Rare and High Mortality Case
%A Sahin Iscan
%A Mustafa Etli
%A Ozgur Gursu
%A Esra Eker
%A Helin El Kilic
%J Case Reports in Vascular Medicine
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/152762
%X Isolated subclavian vein injuries are rarely seen without concomitant arterial injury, bone fracture, damage to brachial plexus, and thoracal traumas. Our case was brought to the emergency service 6 hours after he had been shot at the shoulder with a firearm. After detection of extravasation from the left axillary and subclavian vein on arteriographic and venographic examinations, he was operated on. An autogenous saphenous vein graft was interposed between subclavian and axillary veins. Cardiac arrest developed twice because of hypovolemia, which was resolved with medical therapy. Subclavian vein injuries have a more mortal course when compared with the injuries to the subclavian arteries. Its most important reason is excessive blood loss and air embolism because of delayed arrival to hospital. As is the case in all vascular injuries, angiography is the most important diagnostic examination. If the general health state of the patient permits, arteriography and venography should be performed in patients potentially exposed to vascular injuries. In patients with extreme blood loss and deteriorated health state, direct surgical exploration of the injury site, containment of the bleeding, and venous repair are life-saving approaches. 1. Introduction Many surgeons have not sufficient clinical experience in the management of vascular injuries involving subclavian and axillary regions due to their rarity [1]. These vascular injuries can be accompanied with bone fractures, brachial plexus, and chest injuries. Penetrating injuries are more frequently seen, which include isolated venous (44%), arterial (39%), and mixed vascular (17%) injuries. Most (61%) of these patients could not get a hospital care, and 15% of the operated surgical patients lose their lives. Contrary to expectations, venous injuries (VI) have a more mortal course relative to arterial injuries. Air embolism and excessive blood loss due to delayed referrals to hospital may be the basic reason [2, 3]. In this case report, surgical treatment of a patient, who was brought to hospital with excessive blood loss resulting from being shot at shoulder region with a firearm, with the indication of isolated subclavian vein injury is presented. 2. Case Presentation A 20-year-old male patient was consulted to the emergency service, nearly 6 hours after a firearm injury directed at his left infraclavicular region. Arterial blood pressure was 100/60£¿mm£¿Hg, and heart rate was 105/min. Presumed bullet entrance hole was located nearly 3£¿cm above the left scapula, and its exit hole was approximately 12£¿cm above
%U http://www.hindawi.com/journals/crivam/2013/152762/