Isolated right subclavian artery injury with fractured right first rib following blunt trauma chest

Abstract

Blunt chest trauma uncommonly results in subclavian artery injuries which are protected by subclavius muscle, clavicle, first rib and deep cervical fascia. Subclavian artery injury presents early after trauma. It may rupture to cause haemorrhage, pseudo-aneurysm and brachial plexus compression. Careful physical evaluation of the upper limb is warranted to look for skin colour, temperature, sensation, motor function and radial artery pulses. Serious vascular injury should be suspected if there is presence of large hematomas or pulsatile mass in supraclavicular region. Contrast-CT represents a key diagnostic investigation, while arteriography offers both a diagnostic a therapeutic approach in case endovascular stenting could be contemplated. But surgical repair is preferred mode of management over endovascular stenting in children as it is difficult to manoeuvre a stent in small children and also because stent does not grow with the vessel leading to size mismatch. We report a case of traumatic 2^nd part of right subclavian arterial rupture after blunt trauma chest with fracture involving right first rib following a 10 meters fall from height, treated by open surgical repair of injured right subclavian artery with an interposition 5 mm PTFE graft.