In Reply to: Re: Case 797_04 -- Traumatic left subclavian artery injury posted by anon. on July 19, 1997 at 02:13:38:
1) I agree wholeheartedly that silicone-covered Wallstents should NOT be used intravascularly, based on the Dotter Institute experience in animals.
2) treating this lesion percutaneously and getting a good result might be next to impossible, since by mechanism of injury the tear is most likely centered at the origin of the vessel. I don't think a covered stent would work (unless you put a huge covered stent across the mouth of the subclavian and embolized it distal to the tear to exclude it). In trying to push a stent through there you might well complete the transection anyway.
3) There is some evidence in the surgical literature, though sparse, that conservative management of some injuries that we would not dream of leaving untoughed actually works. I would be interested in a (careful) IVUS of that area to better assess the injury.
4) Please give us a follow-up next mont or sooner!