Subclavian vascular injuries.

This study comprises 228 patients with penetrating injuries of the subclavian vessels. The vein alone was involved in 44 per cent, the artery alone in 39 per cent, and both vessels in 17 per cent. The majority of the victims (61 per cent) did not reach the hospital alive, and in those who were operated on the mortality was 15.5 per cent (overall mortality 66 per cent). The overall mortality of venous injuries was significantly higher than the arterial ones (P less than 0.01), probably because of the dangerous complication of air embolism. Physical examination is reliable in the diagnosis of these injuries and there is no need for an emergency angiogram. The clavicular incision was the preferred approach. Repair was performed in 94 per cent of those with arterial injury. Vein injuries were treated by suture in 60 per cent and ligation in 40 per cent. A selective conservative approach is advised.