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A Journal on Vascular and Endovascular Surgery

Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2003 September;10(3):291-9

language: English, Italian

Dissecting trauma of the extracranial carotid artery. Elective surgical treatment of a stabilized case

Pilato A., Faggioli G. L., Ferri M., Freyrie A.

Cattedra e Unità Operativa di Chirurgia Vascolare Dipartimento di Scienze Chirurgiche e Anestesiologiche Policlinico S. Orsola Università degli Studi di Bologna, Bologna


This ­study ­describes a ­case of sta­bi­lized dis­sect­ing trau­ma of the com­mon carot­id ­artery and relat­ed sur­gi­cal treat­ment. A 46-­year-old man was admit­ted ­because of ­blunt ­neck inju­ry, ­with crush­ing of the ves­sel and symp­toms of dys­ar­thria. Magnetic res­o­nance imag­ing ­showed dis­sec­tion of the ­left com­mon carot­id ­artery at the bifur­ca­tion and a hypo­dense cere­bral ­area in the ­left tem­po­rop­a­rie­tal ­region. Echo Doppler ultra­so­nog­ra­phy con­firmed dis­sec­tion of the inti­ma; flow­me­ter ­study ­showed hemo­dy­nam­i­cal­ly sig­nif­i­cant sten­o­sis. The clin­i­co-neu­ro­log­ic pic­ture was ­stable; sur­gi­cal ­repair of the carot­id ­artery was per­formed. On sur­gery, the ves­sel ­appeared dilat­ed at the lev­el of the ­bulb, where­as the remain­ing por­tion of the com­mon, inter­nal and exter­nal carot­id was nor­mal. On open­ing of the bifur­ca­tion, dis­sec­tion ­with endo­the­lial­iza­tion of the inti­mal ­flap ­were ­observed. A ­PFTA ­graft (6 mm) was fash­ioned in a 5-cm seg­ment ­between the com­mon carot­id and the bifur­ca­tion. Intraoperative angio­graph­ic con­trol ­showed ­good mor­phol­o­gy. Histology ­showed thick­en­ing of the inti­ma, ­with neo­in­ti­mal hyper­pla­sia and dif­fuse fibro­tic are­as, where­as the ­media was affect­ed by lym­pho­mon­o­plas­moc­y­tary infil­tra­tion.
The post­op­er­a­tive ­course was unevent­ful and the ­patient was dis­charged on the 7th day ­with anti­plate­let ther­a­py. On post­op­er­a­tive fol­low-up at 12 ­months, ­echo Doppler sonog­ra­phy ­showed the ­graft to be pat­ent, ­with no inter­nal mor­pho­log­ic or flow­me­ter chang­es. Blunt inju­ries to the extra­cra­ni­al carot­id ­artery can ­lead to ves­sel ­wall dam­age, ­with ­acute and/or pro­gres­sive neu­ro­log­ic ­events ­that ­require emer­gen­cy ­repair. If the neu­ro­log­ic pic­ture is sta­bile, and the carot­id ­lesion ­does not ­tend to rap­id pro­gres­sion, elec­tive ­repair sur­gery is indi­cat­ed ­instead. Repair is essen­tial ­when the ­lesion deter­mines sig­nif­i­cant hemo­dy­nam­ic alter­a­tions.

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