Zhu, Yunke; Zheng, Quan; Liao, Hu; Mei, Jiandong; Kocher, Gregor J; Shimizu, Kimihiro; Ma, Lin (2022). Successful thoracoscopic management of iatrogenic left subclavian arterial injury: a case report. Journal of thoracic disease, 14(1), pp. 194-198. AME Publishing Company 10.21037/jtd-21-1922
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The subclavian artery at the thoracic outlet is in the deepest position of the thoracic cavity and is difficult to repair in this narrow space once injured, even if the surgery is converted to a thoracotomy. This article presents a successful left subclavian artery repair procedure at the thoracic outlet using a thoracoscopic approach, with a video demonstration, and describes its technical characteristics. The patient was planned for a left upper lobectomy through three-port thoracoscopic approach. Severe adhesions were found intraoperatively and an accidental left subclavian arterial injury occurred when dissecting the adhesions. We first clamped the proximal portion of the subclavian artery and then directly clamped the rupture site. Our first suture failed due to the limited suture angle and the mutual restriction between the needle holder and atraumatic vascular clamp. To freely control the needle holder, another assistant port was made in the seventh intercostal space (ICS). The arterial injury was finally successfully repaired using pledgetted suture. The operation time was 235 minutes and intraoperative blood loss was 800 mL. The pulsation of the left radial artery was normal postoperatively, and the patient was discharged on postoperative day 6. Appropriate strategies allow attempts to manage intraoperative hyperbaric arterial bleeding from the systemic circulation, such as bleeding caused by subclavian arterial injuries, by means of a thoracoscopic approach without conversion to thoracotomy.
Item Type: |
Journal Article (Further Contribution) |
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Division/Institute: |
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Thoracic Surgery |
UniBE Contributor: |
Kocher, Gregor |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2072-1439 |
Publisher: |
AME Publishing Company |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
07 Mar 2022 12:11 |
Last Modified: |
05 Dec 2022 16:12 |
Publisher DOI: |
10.21037/jtd-21-1922 |
PubMed ID: |
35242381 |
Uncontrolled Keywords: |
Thoracoscopy case report massive hemorrhage subclavian arterial injury |
BORIS DOI: |
10.48350/166592 |
URI: |
https://boris.unibe.ch/id/eprint/166592 |
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