DR. MANOJ ADITYA B,DR. BHARATHI B,DR. N. VIVEK RAJASIMHAN
DOI: https://doi.org/Background:
Subclavian–axillary artery injuries are rare but life-threatening events, often associated with high-energy trauma or iatrogenic causes. Their proximity to vital neurovascular structures presents unique challenges for both surgical and anesthetic teams. Prompt recognition and coordinated multidisciplinary intervention are critical for patient survival.
Case Presentation:
We report the anesthetic management of a patient with subclavian–axillary artery rupture requiring emergency surgical repair. The patient underwent general anesthesia with endotracheal intubation and was induced using intravenous fentanyl, vecuronium, and isoflurane. Comprehensive intraoperative monitoring included electrocardiography, pulse oximetry, end-tidal CO₂, core temperature, invasive arterial pressure, central venous pressure, and central venous cannulation. Hemodynamic instability persisted throughout, necessitating double inotropic support. Surgical intervention involved a median sternotomy and bypass grafting from the second part of the subclavian artery to the axillary artery using a 6 × 300 mm Dacron graft. Intraoperatively, the patient developed cardiac arrest, managed with direct cardiac compressions, intravenous adrenaline, atropine, sodium bicarbonate, and internal defibrillation (30 J), resulting in return of spontaneous circulation.
Conclusion:
This case underscores the complexity of anesthetic management in subclavian–axillary artery injuries, highlighting the need for vigilant hemodynamic monitoring, preparedness for massive transfusion and advanced resuscitation, and close coordination with the surgical team. Early recognition and a multidisciplinary approach remain key to improving outcomes in these high-risk vascular emergencies.
