Endovascular Repair of Intraoperative Penetrating Injury to the Subclavian Vein: Case Report, Technical Considerations and Literature Review

Penetrating injury to the subclavian vein is an uncommon, but potentially life-threatening event. Surgical repair is technically demanding due to the vessel's deep location beneath the clavicle, the narrow operative field, and the proximity of vital structures. Reported experience on endovascular techniques for subclavian venous injuries (SVI) remains limited. We present the case of a 60-year-old woman who sustained iatrogenic injury of the left subclavian vein during lateral cervical lymph node dissection for invasive thyroid carcinoma. Attempts at open hemostasis were unsuccessful, due to the depth and extent of the injury. Emergency endovascular repair with rapid deployment of an 11 × 50 mm Viabahn® self-expanding stent-graft resulted in immediate exclusion of the injury. The patient recovered uneventfully, and was discharged on postoperative day 3, under anticoagulation with direct oral anticoagulant at therapeutic dosage. Follow-up colored Duplex ultrasonography demonstrated good stent-graft patency. Contrast-enhanced computed tomography venography at 12 months confirmed the durable results, without thrombosis, stenosis, or migration. At 2-year follow-up, the patient remains asymptomatic, with a fully patent venous stent-graft. This case highlights the feasibility, safety, and durability of endovascular repair in managing SVI, and underscores the importance of rapid decision-making, proper anticoagulation, and rigorous postoperative surveillance in these rare but critical scenarios.