Through-and-through wire technique for endovascular damage control in traumatic proximal axillary artery transection

Repair of blunt shoulder trauma with transection of the subclavian or proximal axillary artery poses a surgical challenge, especially in instable patients. Endovascular treatment for initial damage control in arterial transection has evolved as a promising technique to improve outcome, but technical success can be limited in cases of complete transection as the lesion cannot be passed by a guidewire. This report describes an endovascular approach using a through-and-through brachial–femoral wire to control complete traumatic transection of the proximal axillary artery in a hemodynamically unstable patient. Endovascular therapy is used as a bridging method for open surgical repair three days later under optimized conditions with an interdisciplinary team. The brachial–femoral guidewire technique helps to overcome limitations in endovascular therapy in patients with blunt traumatic transection of thoracic outlet arteries.