Outcomes Comparison of Endovascular and Open Surgical Approaches for Subclavian Arterial Injury: A Nationwide Analysis

Background: The management of patients with subclavian artery injury is rapidly evolving from an open to an endovascular approach. We aim to present an analysis of management and a comparison of outcomes according to the type of approach used to treat these challenging injuries.

Methods: Adult patients with subclavian arterial injuries were abstracted from the National Inpatient Sample database from 2012 to 2014 and 2016 to 2021. Patients were divided according to the type of management, which was endovascular management (EM; stent placement) or open surgery (OS), and clinical outcomes were compared. A multivariable logistic regression model was utilized to determine risk factors associated with in-hospital mortality.

Results: A total of 1200 cases were analyzed. The EM and OS groups had similar baseline characteristics, including age, sex, APRDRG severity of illness and risk of mortality scores, and Charlson Comorbidity Scores. The presence of shock on admission was similar between groups (EM: 23.1% vs. OM:34.2%; p=0.115). Median ISS was higher in the EM group but with a lower mortality rate (5.5% vs. 14.8%, p = 0.045) than OA. Additionally, EM was associated with a lower fasciotomy rate (p = 0.018). Hemorrhagic shock on presentation (OR: 3.72) was associated with a marked increase in the odds of in-hospital mortality, while EM was associated with a 67% decrease (OR: 0.33).

Conclusion: EM is associated with significantly better outcomes, including lower odds of in-hospital mortality and a decreased need for fasciotomy. Currently, EM is a feasible option in the management of subclavian arterial injuries.