S25.19

Clinical Causes: Trauma from car accidents or falls Penetrating injuries from stab or gunshot wounds Blunt force trauma during sports or physical altercations Iatrogenic injuries following surgical procedures in the neck or chest Accidental injury during medical procedures involving the neck or upper chest

Key Symptoms: Pain or tenderness in the neck, shoulder, or chest areas Swelling or bruising near the injury site Signs of blood loss such as dizziness, weakness, or rapid heartbeat Difficulty moving or numbness in the affected arm or hand Possible visible bleeding if the injury is open Pale or cold extremities indicating compromised blood flow Respiratory distress if bleeding affects nearby structures Possible presence of a pulsatile mass if the artery is damaged and forms a pseudoaneurysm

Diagnosis Path: The diagnostic process involves a combination of physical examination and imaging studies. Initial assessment focuses on identifying the severity of hemorrhage and neurological compromise. Imaging techniques include: - **Computed Tomography Angiography (CTA):** Provides detailed images of blood vessels and helps locate the injury - **Magnetic Resonance Angiography (MRA):** Used in certain cases to avoid radiation exposure - **Ultrasound (Doppler):** Assists in assessing blood flow and detecting hematomas - **Conventional Angiography:** Often employed when planning surgical or endovascular intervention Laboratory tests such as blood counts and blood type determination can support the overall assessment, especially in cases of significant blood loss.

Treatment Protocols: Management of innominate or subclavian artery injuries depends on the severity and extent of the damage. Typical approaches include: - **Emergency stabilization:** Control of bleeding and restoration of blood volume, often with fluid resuscitation and blood transfusions - **Surgical intervention:** May involve repairing the damaged artery through open surgery, including techniques such as vascular repair, patch angioplasty, or bypass grafting - **Endovascular procedures:** Minimally invasive options like stent placement or embolization can be used for certain injuries, especially in high-risk surgical candidates - **Monitoring and supportive care:** Close observation for signs of rebleeding, thrombosis, or ischemia, along with medications such as anticoagulants or antiplatelet agents as appropriate Follow-up care is essential to monitor for complications such as pseudoaneurysm formation or arterial stenosis, and to ensure proper healing and vascular function.