Urgent endovascular treatment of iatrogenic subclavian artery rupture: report of three cases.

The increased use of central venous catheters in modern medical practice has brought a proportional increase in the number of cases of iatrogenic vascular injuries. Concerning the subclavian artery, the site of the lesion and the vessel size demand urgent and effective treatment in order to obtain a favorable prognosis. It has been common practice for a long time to consider this type of lesion as a surgical emergency. Nevertheless, emerging endovascular interventional procedures appear to offer an alternative that is effective and safe as well. We hereby report three cases of subclavian artery injury, in which repair was achieved by endovascular approach with the placement of a cover stent. Hypovolemic shock (demonstrated in two patients) as well as brachial plexus palsy due to pseudoaneurysm of the subclavian artery (presented in another patient) were successfully managed by percutaneous brachial (in two patients) or right femoral (in the patient with the pseudoaneurysm) approach and placement of balloon expandable covered stents (4-9 mm x 38 mm). No procedure-related complications were observed. Short-term follow-up results in two of the three patients were quite satisfactory concerning patency.