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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2000 June;41(3):423-31

language: English

Carotid artery injuries and their management

Mittal V. K., Paulson T. J., Colaiuta E., Habib F. A., Penney D. G., Daly B. *, Young S. C.

From the Department of Surgery, Providence Hospital, Southfield, MI and *Grace Hospital, Detroit, MI, USA


Background. Major vas­cu­lar inju­ries in the ­region of the ­neck are ­most fre­quent­ly the ­result of pen­e­trat­ing trau­ma. Evaluation and man­age­ment of ­patients ­with inju­ry to Zone II of the ­neck ­remains high­ly con­tro­ver­sial. Most stud­ies ­involve ­small num­ber of ­patients ­with a ­lack of stan­dard­iza­tion of the ­nature of the inju­ry in report­ing out­come. It is the pur­pose of ­this ­study to pro­pose a grad­ing ­scale for vas­cu­lar inju­ries in the ­neck ­that ­would ­allow for ­more uni­form report­ing of ­such inju­ries.
Methods. Experimental ­design: A ret­ro­spec­tive ­review of all ­patients treat­ed for pen­e­trat­ing trau­ma to the ­neck was per­formed and the sub­set of ­patients ­with ­major vas­cu­lar inju­ries iden­ti­fied. Data ­from ­this ­group of ­patients are pre­sent­ed. Setting: Level II ­urban trau­ma cen­ter. Patients and inter­ven­tions: During the peri­od July 1984 to June 1994, 107 ­patients ­were treat­ed for pen­e­trat­ing ­neck trau­ma. Injuries to the ­major arter­ies of the ­neck ­were ­present in 18 of the 107 ­patients (16.8%). All inju­ries ­were grad­ed on the devel­oped ­scale. Management pro­to­col was ­based on the ­grade of the inju­ry. Grade 1 inju­ries ­were man­aged non-oper­a­tive­ly ­with system­ic anti­co­ag­u­la­tion and low molec­u­lar ­weight dex­tran. Grade 2 inju­ries ­were treat­ed ­with pri­mary ­repair. Injuries of Grades 3 and 4 ­were treat­ed by pri­mary ­repair or inter­po­si­tion ­graft. Exceptions ­were iso­lat­ed inju­ries of the exter­nal carot­id ­artery, ­which ­were treat­ed by liga­tion ­alone.
Results. Of the 18 ­patients ­with carot­id ­artery inju­ries, 2 had inju­ries of the exter­nal carot­id ­artery, treat­ed ­with liga­tion ­alone. The inter­nal carot­id ­artery was ­injured in 7 cas­es. An inter­po­si­tion saph­e­nous ­vein/PTFE ­graft was ­used in all cas­es. In 9 cas­es the com­mon carot­id ­artery was ­injured. Repair was accom­plished by a com­bi­na­tion of ­either a pri­mary ­repair or inter­po­si­tion ­graft. Overall mor­tal­ity was 3/16 (16.6%). No new or wors­en­ing of neu­ro­log­ic def­i­cit ­occurred in any ­patient.
Conclusions. Carotid ­artery inju­ries ­occur in ­about 17% of ­patients ­with pen­e­trat­ing ­neck trau­ma. Data regard­ing man­age­ment and prog­no­sis in ­these ­patients are at ­best conc­flict­ing, in ­part, due to ­lack of a stan­dard­ized clas­sifi­ca­tion ­system. The pro­posed grad­ing ­scale is ­designed to over­come ­this prob­lem.

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