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Year : 2016  |  Volume : 1  |  Issue : 2  |  Page : 67-70

Left subclavian artery injury: Is there still a role for trap door incision in the minimally invasive Era?

Dr. Joe Nwiloh Heart Center, St. Joseph's Hospital, Adazi-Nnukwu, Anambra State, Nigeria

Correspondence Address:
Jonathan Nwiloh
Dr. Joe Nwiloh Heart Center, St. Joseph's Hospital, Adazi-Nnukwu, Anambra State
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2468-7391.195957

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The surgical approach to the management of subclavian artery injuries is usually guided by the location and clinical presentation. With the advent of endovascular surgery, many surgeons are likely to have limited experience with the trap door approach sometimes necessary for control and repair of proximal left subclavian artery (LSA) injuries due to their relative rarity. A 69-year-old male sustained a left lower neck stab wound 3 weeks before his presentation with a pulsatile left supraclavicular swelling, weak radial pulse, and upper extremity weakness. Duplex ultrasound scan revealed a pseudoaneurysm confirmed on computed tomography angiogram and shown to be fed from the LSA. The patient successfully underwent elective open surgical repair of the injury located in the first portion of the subclavian artery through a trap door approach. Although the injury might have been treated minimally invasively with endovascular repair, this technique is currently not available in Nigeria and most Sub-Saharan African countries. Surgery remains the only treatment option for these types of injuries in low-resource countries. Surgeons involved in the management of vascular injuries should, therefore, be conversant with all surgical approaches, including the trap door incision which should be part of their armamentarium.

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