Hybrid Operating Theater Could Increase Role of Endovascular Adjuncts in Peripheral and Thoracic Outlet Vascular Trauma

Trauma is one of the leading causes of mortality and morbidity especially in the young or middle age group. The lethal triad of trauma (hypothermia, coagulopathy, and acidosis) is almost always triggered by initial uncontrolled or concealed hemorrhage. Time is of utmost importance in terminating the vicious cycle. Endovascular interventions along with open surgical management in a hybrid suite not only decrease surgical time, avoid exposure to anesthesia, hasten recovery, but most importantly breakdown the catastrophic sequelae of ongoing bleed by rapid hemorrhage control. They allow vascular control at difficult surgical terrains such as subclavian or iliac vessels with much compared ease and rapidity. We present four interesting cases of peripheral and thoracic outlet vascular trauma and its sequelae managed with endovascular adjuncts at different points in the resuscitative and rehabilitation stations. In our first case of a stab injury over the right femoral artery with acute hemorrhage, a covered stent across the transected artery was curative as well as hastened recovery. In the second case in the hybrid suite, a long segment of balloon occlusion of the iliac artery allowed rapid physiology control and easier surgical repair of the transected common femoral vessels. The third case required a covered stent across the leak from a previously repaired subclavian vessel to prevent life-threatening hemothorax. In another interesting case of a badly mutilated posttraumatic shoulder with an axillary pseudo-aneurysm, a covered stent across the axillary vessel facilitated further reconstructive shoulder surgery.