Management of Traumatic Vascular Injuries to the Neck: A 7-Year Experience at a Level I Trauma Center

2012 ◽  
Vol 78 (3) ◽  
pp. 335-338 ◽  
Author(s):  
Jon D. Simmons ◽  
Naveed Ahmed ◽  
Kimberly A. Donnellan ◽  
Robert E. Schmieg ◽  
John M. Porter ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Trauma Center ◽  
Chart Review ◽  
Jugular Vein ◽  
Penetrating Trauma ◽  
Vascular Injuries ◽  
Mortality And Morbidity ◽  
Carotid Artery Injuries ◽  
Level I ◽  
Significant Mortality

Injury to the carotid artery results in significant mortality and morbidity. The general consensus is to repair all injuries to the common and internal carotid arteries. Ligation is usually reserved for neurologic or hemodynamic instability. We report our experience at a Level I trauma center with vascular injuries to the neck. Retrospective chart review of all patients with vascular injuries in the neck resulting from either blunt or penetrating trauma treated at a Level I trauma center between January 2000 and February 2007. Demographics and outcomes were collected from a chart review. Twenty-five patients with vascular injuries to the neck were identified. There were 13 carotid artery injuries (CAI), five internal jugular vein (IJV) injuries, and 13 external jugular vein (EJV) injuries. Of the carotid artery injuries, six (50%) underwent operative repair (4 primary repairs and 2 bypasses), five (38%) were managed nonoperatively, and one was treated using endovascular techniques. No patient had a postoperative decrease in Glasgow Coma Scale score. There were five isolated IJV injuries (3 primary repair and 2 ligations). Four of the venous injuries (all internal jugular veins) were repaired and the remaining 13 were ligated. Vascular injuries to the neck have significant mortality and morbidity. Treatment of these injuries must be individualized. All CAI in noncomatose patients should be repaired if hemodynamically stable. All IJV injuries should be repaired but may be ligated if hemodynamically unstable. All EJV injuries can be ligated without reservation regardless of neurological status.

scholarly journals Correction of carotid-jugular traumatic fistula using a bovine pericardial patch

2014 ◽  
Vol 13 (1) ◽  
pp. 53-57 ◽  
Author(s):  
Werther Souza Sales ◽  
Fabio Augusto Cypreste Oliveira ◽  
Fabio Henrique Ribeiro de Souza ◽  
Handel Meireles Borges Filho ◽  
Juliano Ricardo Santana Santos ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Arteriovenous Fistula ◽  
Common Carotid Artery ◽  
Gunshot Wound ◽  
Jugular Vein ◽  
Penetrating Trauma ◽  
Pericardial Patch ◽  
Bovine Pericardial Patch ◽  
The Common ◽  
Cervical Area

Carotid-jugular fistulae are rare, but habitually cause morbidity and mortality. They are often linked with penetrating trauma, primarily caused by gunshots. This report describes the case of a patient who was the victim of a gunshot wound to the left cervical area, provoking a carotid-jugular arteriovenous fistula and occlusion of the common carotid artery. The fistula was corrected by ligature of the internal jugular vein and arteriorrhaphy of the left common carotid artery with a bovine pericardium patch.

Management of Penetrating Cerebrovascular Injuries in Pediatric Trauma: A Retrospective Multicenter Study

Neurosurgery ◽  
2017 ◽  
Vol 81 (3) ◽  
pp. 473-480 ◽  
Author(s):  
Vijay M. Ravindra ◽  
Michael C. Dewan ◽  
Hassan Akbari ◽  
Robert J. Bollo ◽  
David Limbrick ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Open Surgery ◽  
Pediatric Trauma ◽  
Penetrating Trauma ◽  
Neurological Deficits ◽  
Treatment Modalities ◽  
Blunt Cerebrovascular Injury ◽  
Cerebrovascular Injury ◽  
Carotid Artery Injuries ◽  
Grade Iii

Abstract BACKGROUND: Blunt cerebrovascular injury is uncommon in the pediatric population; penetrating cerebrovascular injuries are even rarer and are thus poorly understood. OBJECTIVE: To describe the diagnosis and management of penetrating cerebrovascular injuries and describe outcomes of available treatment modalities. METHODS: Clinical and radiographic data were collected retrospectively from a multicenter trauma registry for children screened for cerebrovascular injury during 2003 to 2013 at 4 academic pediatric trauma centers. RESULTS: Among 645 pediatric patients evaluated with computed tomography angiography with blunt cerebrovascular injury, 130 also had a penetrating trauma indication. Seven penetrating cerebrovascular injuries were diagnosed in 7 male patients (mean age 12.4 years, range 12-18 years). Focal neurological deficit and concomitant intracranial injury were each seen in 2 patients. There were 2 intracranial carotid artery injuries, 4 extracranial carotid artery injuries, and 1 vertebral artery injury. The majority of injuries were higher than grade I (5/7; 71%): 2 were grade I, 1 grade II, 2 grade III, and 2 grade IV. The 2 patients with grade III injuries required open surgery, and 1 patient with a grade IV injury underwent endovascular treatment. Two patients suffered immediate stroke secondary to the penetrating cerebrovascular injury. There were no delayed neurological deficits from the penetrating injuries, and no patients died as a result of the injuries. CONCLUSION: This is the largest series of penetrating cerebrovascular trauma in the pediatric literature. Although rare, penetrating cerebrovascular injuries can be high-grade injuries that require urgent recognition and may require aggressive endovascular and/or open surgery for treatment.

More is Not Better: Implications of Antibiotic Practice Management Guidelines for Penetrating Trauma Hollow Viscus Injury in a Level I Trauma Center

2019 ◽  
Vol 85 (11) ◽  
pp. 530-532
Author(s):  
David T. Pointer ◽  
Alison Smith ◽  
Douglas P. Slakey ◽  
Danielle Tatum ◽  
Lili E. Schindelar ◽  
...  
Keyword(s):  
Trauma Center ◽  
Penetrating Trauma ◽  
Practice Management ◽  
Hollow Viscus ◽  
Management Guidelines ◽  
Hollow Viscus Injury ◽  
Level I

scholarly journals Clinical and radiographic outcomes following traumatic Grade 1 and 2 carotid artery injuries: a 10-year retrospective analysis from a Level I trauma center. The Parkland Carotid and Vertebral Artery Injury Survey

2015 ◽  
Vol 122 (5) ◽  
pp. 1196-1201 ◽  
Author(s):  
William W. Scott ◽  
Steven Sharp ◽  
Stephen A. Figueroa ◽  
Alexander L. Eastman ◽  
Charles V. Hatchette ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cerebral Infarction ◽  
Vertebral Artery ◽  
Management Plan ◽  
Low Grade ◽  
Radiographic Outcomes ◽  
Vessel Lumen ◽  
Carotid Artery Injuries ◽  
Level I

OBJECT Proper screening, management, and follow-up of Grade 1 and 2 blunt carotid artery injuries (BCIs) remains controversial. These low-grade BCIs were analyzed to define their natural history and establish a rational management plan based on lesion progression and cerebral infarction. METHODS A retrospective review of a prospectively maintained database of all blunt traumatic carotid and vertebral artery injuries treated between August 2003 and April 2013 was performed and Grade 1 and 2 BCIs were identified. Grade 1 injuries are defined as a vessel lumen stenosis of less than 25%, and Grade 2 injuries are defined as a stenosis of the vessel lumen between 25% and 50%. Demographic information, radiographic imaging, number of imaging sessions performed per individual, length of radiographic follow-up, radiographic outcome at end of follow-up, treatment(s) provided, and documentation of ischemic stroke or transient ischemic attack were recorded. RESULTS One hundred seventeen Grade 1 and 2 BCIs in 100 patients were identified and available for follow-up. The mean follow-up duration was 60 days. Final imaging of Grade 1 and 2 BCIs demonstrated that 64% of cases had resolved, 13% of cases were radiographically stable, and 9% were improved, whereas 14% radiographically worsened. Of the treatments received, 54% of cases were treated with acetylsalicylic acid (ASA), 31% received no treatment, and 15% received various medications and treatments, including endovascular stenting. There was 1 cerebral infarction that was thought to be related to bilateral Grade 2 BCI, which developed soon after hospital admission. CONCLUSIONS The majority of Grade 1 and 2 BCIs remained stable or improved at final follow-up. Despite a 14% rate of radiographic worsening in the Grade 1 and 2 BCIs cohort, there were no adverse clinical outcomes associated with these radiographic changes. The stroke rate was 1% in this low-grade BCIs cohort, which may be an overestimate. The use of ASA or other antiplatelet or anticoagulant medications in these low-grade BCIs did not appear to correlate with radiographic injury stability, nor with a decreased rate of cerebral infarction. Although these data suggest that these Grade 1 and 2 BCIs may require less intensive radiographic follow-up, future prospective studies are needed to make conclusive changes related to treatment and management.

Hybrid repair of proximal subclavian artery transection

Trauma ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 316-319
Author(s):  
Aleksandra Staniszewska ◽  
Muzaffar Anwar ◽  
Mohamad Hamady ◽  
David Nott
Keyword(s):  
Carotid Artery ◽  
Clinical Outcome ◽  
Subclavian Artery ◽  
Endovascular Therapy ◽  
Distal Segment ◽  
Vascular Plug ◽  
Mortality And Morbidity ◽  
Hybrid Repair ◽  
Excellent Clinical Outcome ◽  
Significant Mortality

Although rare, subclavian artery injuries are associated with significant mortality and morbidity, with almost two-thirds of patients dying before reaching hospital. Recent advances in technology have resulted in increasing use of endovascular therapy in management of these injuries. In this report, we present a case of a successful hybrid repair of traumatic left proximal subclavian artery transection. The employment of an Amplatzer Vascular Plug to control a short proximal subclavian artery stump and subsequent ligation of the distal segment of subclavian artery with its anastomosis to the carotid artery resulted in excellent clinical outcome without performing a sternotomy in a young patient.

Nocturnal Violence: Implications for Resident Trauma Operative Experiences

2012 ◽  
Vol 78 (6) ◽  
pp. 657-663 ◽  
Author(s):  
Colyn J. Watkins ◽  
Paul L. Feingold ◽  
Barry Hashimoto ◽  
Laura S. Johnson ◽  
Christopher J. Dente
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Time Of Day ◽  
Operative Intervention ◽  
Peak Time ◽  
Trauma Patients ◽  
Time Period ◽  
Work Hour ◽  
Level I

Trauma centers face novel challenges in resource allocation in an era of cost consciousness and work-hour restrictions. Studies have shown that time of day and day of week affect trauma admission volume; however, these studies were performed in cold climates. Data from 2000 to 2010 at a Level I trauma center were reviewed. Demographic, injury severity, and injury timing from 23,827 trauma patients were analyzed along with their emergency department disposition (operating room, intensive care unit, ward) and final outcome. Nighttime arrivals (NAs) accounted for 56.6 per cent and daytime arrivals accounted for 43.4 per cent of total admissions. The increase in NAs was most pronounced during the period from midnight to 6 AM on weekends ( P < 0.05). Also, the period from midnight to 6 AM on weekends showed a significantly increased proportion of penetrating trauma ( P < 0.01). Similarly, there was an increased rate of trauma arrivals needing emergent operative intervention in the period between midnight and 6 AM on weekends when compared with any other time period ( P < 0.01). In a southern Level I trauma center, patient volume varies nonrandomly with time. Emergent operative intervention is more likely between midnight and 6 AM, the peak time for penetrating trauma. Because resident operative experience is maximized at night and on weekends, coverage during these periods should remain a priority for residency programs.

Level I Verification Is Associated with a Decreased Mortality Rate after Major Torso Vascular Injuries

2011 ◽  
Vol 77 (1) ◽  
pp. 32-37 ◽  
Author(s):  
Scott Norwood ◽  
Alan D. Cook ◽  
John D. Berne
Keyword(s):  
Mortality Rate ◽  
Trauma Center ◽  
Mortality Rates ◽  
Population Based ◽  
Entire Group ◽  
Vascular Injuries ◽  
Thoracic Injuries ◽  
Level Ii ◽  
Level I ◽  
Community Trauma

Major torso vascular injuries (MTVIs) are frequently fatal. Our purpose was to determine whether the American College of Surgeons’ (ACS) trauma center level of verification was associated with reduced mortality rates in a rural population-based community trauma center. Patients with blunt and penetrating MTVIs were retrospectively reviewed. Mortality rates were compared between Level II and Level I verification time periods. The primary outcome measured was death from MTVIs. Two hundred seventy-four patients (blunt, 167 [61%]; penetrating, 107 [39%]) representing 1.5 per cent of all trauma admissions were studied. Mortality decreased from 41 of 80 (51%) (Level II) to 60 of 194 (31%) (Level I) ( P = 0.002) for the entire group. Mortality reduction occurred primarily in the subgroup with blunt and penetrating thoracic injuries (Level II, 24 of 33 [73%] vs Level I, 25 of 82 [30%]; P < 0.001). A significant reduction was not observed in patients with major abdominal vascular injuries (Level II, 17 of 47 [36%] vs Level I, 35 of 112 [31%]; P = 0.581). Level I status was associated with an overall decreased mortality rate from MTVIs despite low patient numbers. The commitment of hospital resources that are required to achieve Level I ACS verification in a community hospital improves survival, particularly in patients with blunt and penetrating thoracic injuries.

CT Angiography Effectively Evaluates Extremity Vascular Trauma

2008 ◽  
Vol 74 (2) ◽  
pp. 103-107 ◽  
Author(s):  
Peter D. Peng ◽  
David A. Spain ◽  
Monika Tataria ◽  
Jeffrey C. Hellinger ◽  
Geoffrey D. Rubin ◽  
...  
Keyword(s):  
Trauma Center ◽  
Imaging Modality ◽  
Arterial Injury ◽  
Computed Tomographic Angiography ◽  
Vascular Trauma ◽  
Vascular Imaging ◽  
Vascular Injuries ◽  
Peripheral Vascular ◽  
Diagnostic Modality ◽  
Level I

Traditionally, conventional arteriography is the diagnostic modality of choice to evaluate for arterial injury. Recent technological advances have resulted in multidetector, fine resolution computed tomographic angiography (CTA). This study examines CTA for evaluation of extremity vascular trauma compared with conventional arteriography. Our hypothesis is that CTA provides accurate and timely diagnosis of peripheral vascular injuries and challenges the gold standard of arteriogram. Traumatic extremity injuries over a 5-year period were identified using a Level I trauma center registry and radiology database. Information collected included patient demographics, mechanism, imaging modality, vascular injuries, management, and follow-up. Two thousand two hundred and fifty-one patients were identified with extremity trauma. Twenty-four patients were taken directly to the operating room for evaluation and management of vascular injuries. Fifty-two underwent vascular imaging. Fourteen patients had conventional arteriograms with 13 abnormal studies: 7 were managed operatively, 2 embolized, and 4 observed. Thirty-eight patients underwent CTA with 17 abnormal scans: 9 were managed operatively, 3 embolized, and 5 observed. There were no false negatives or missed injuries. CTA provides accurate peripheral vascular imaging while additionally offering advantages of noninvasiveness and immediate availability. Secondary to these advantages, CTA has supplanted arteriography for initial radio-graphic evaluation of peripheral vascular injuries at our Level I trauma center. This study supports CTA as an effective alternative to conventional arteriography in assessing extremity vascular trauma.

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