Safety and Efficacy of Transcatheter Embolization of Axillary and Shoulder Arterial Injuries

The authors performed 13 transcatheter embolizations (TCEs) within the axilla and shoulder in nine patients with major trauma to one or more vessels in these regions. Indications for TCE included active hemorrhage, pseudoaneurysms, arteriovenous fistulas (AVFs) caused by penetrating trauma, and a postsurgical AVF. Embolizations were performed within branches of the subclavian, axillary, and brachial arteries in nine male patients aged 20–38 years. All procedures were performed with use of either Gianturco coils or Hilal wires, with or without gelatin sponge pledgets or autologous clot. Nine of 11 procedures in eight patients resulted in successful treatment of active bleeding, pseudoaneurysms, and AVFs, thus enabling avoidance of surgery. After two embolizations in the ninth patient, TCE failed to occlude an AVF, necessitating surgical treatment. Only one complication (asymptomatic pulmonary embolization with Gianturco coils) was encountered in this series. No neurologic sequelae occurred. The authors' experience demonstrates the safety and efficacy of TCE in the nonsurgical management of axillary and shoulder hemorrhage and vascular injuries secondary to penetrating trauma and surgical complications.