A hybrid strategy of endovascular embolization and carotid–axillary bypass for traumatic subclavian artery transection: A case report

Background. Traumatic subclavian vascular injury (TSVI) is rare but poses significant challenges in surgical management. Both open and endovascular approaches are available; however, each carries limitations under specific circumstances. Hybrid techniques may offer a feasible alternative, especially when conventional methods fail. Case presentation. A 37-year-old man presented to the emergency department after a motorcycle collision with a transected left subclavian artery, upper extremity paralysis, and a cold, pale hand. Bidirectional endovascular revascularization attempts were unsuccessful. A single-session hybrid strategy—combining endovascular coiling with carotid-axillary bypass—was performed, restoring limb perfusion. Although brachial plexus injury limited immediate neurological recovery, adequate circulation was preserved, preventing amputation. The patient demonstrated rapid functional recovery during follow-up. Conclusions. This case highlights the value of a hybrid approach for managing TSVI when conventional endovascular repair fails. Combining embolization with extra-anatomic prosthetic bypass can provide an effective salvage strategy, ensuring limb salvage and supporting postoperative rehabilitation.