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

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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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