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Page 4 of 5 Kao et al. Vessel Plus 2018;2:18 I http://dx.doi.org/10.20517/2574-1209.2018.42

Figure 4. The wound of the patient. The white arrow points out the approach site of endovascular procedure which is the brachial artery
near elbow. The black arrow is the insertion site of the pigtail tube while the white arrowhead points out the wound created by the
surgeon at our satellite hospital in attempt to approach the bleeder

®
injuries to axillo-subclavian artery, there were very few cases repaired by endoprosthesis (GORE VIA-
BAHN® Endoprosthesis, W.L. Gore and Associates, Inc. Flagstaff, AZ) that we chose for our patient [3,8,14,15] .

Based on what was mentioned above, we wish to deliver a few messages. First of all, there is a potential risk
of non-vascular procedure in causing axillary artery penetrating injury. In trauma such as our case, the
site of hematoma was at upper chest which was very close to axillo-subclavian artery anatomically. When
approaching the lesion with percutaneous procedures such as pigtail catheter drainage, penetrating injury
could happen.

Secondly, we also demonstrated the safety and instantaneity of endovascular repair in case of penetrating
axillo-subclavian artery with ruptured pseudoaneurysm. As mentioned above, the complexity of anatomical
structure over axillo-subclavian artery makes it difficult to approach the vessels openly. While patients with
such injuries might be too critically ill, open surgery might not be able to provide timely repair. In compari-
son, endovascular has the potential to provide a safer, quicker and more secure approach to repair of pen-
etrating injuries to axillo-subclavian artery.

DECLARATIONS
Acknowledgments
Lu MS, Lin CC, Tseng YH helped to proofreading the draft.

Authors’ contributions
Drafted the manuscript, and collected the proper images: Kao CC
Conceived of the study and helped to proofreading the draft: Huang YK
Read and approved the final manuscript: both authors

Availability of data and materials
The data in the study was collected from the medical record of the patient in Chiayi Chang Gung Memorial
Hospital. The patient has agreed to provide his data for study.

Financial support and sponsorship
Huang YK has sources of funding including research number CMRPG380841, CMRPG6C0342, CMRP-
G6B0503, NMRPG6D022, CMRPG6E0421.