Karotisverletzungen

Introduction: Injuries of the carotid artery constitute a rare group of injuries. This study presents results of the treatment of 44 patients with iatrogenic carotid artery injuries for over 20 years. The patients were treated by the team of doctors of the Department of Vascular, General and Transplant Surgery in Wroclaw in the years 1997–2017 (Head of the Department Prof. Klemens Skóra, MD, and Prof. Piotr Szyber, MD, PhD – material used with permission). Aim: Aims of the analysis are: to estimate the frequency of different forms of iatrogenic injuries to the common and internal carotid artery, to evaluate the results of treatment, to assess the most effective surgical method depending on the type of injury, and develop an effective preoperative, intraoperative and postoperative regimen. Discussion and results: The frequency of various carotid artery injuries (blunt, acute, traffic) was constant between years, but the number of iatrogenic injuries definitely increased over time. The prognosis for patients with carotid artery injury, especially when combined with multi-organ trauma, is the gravest. Significantly better treatment results were achieved with both acute and iatrogenic injuries. This is mainly due to easier and quicker diagnosis and better conditions for assisting patients. Conclusions: In iatrogenic injuries, a well-designed surgical scheme, i.e. primarily the administration of UTH and placing a temporary suction drain by the first operating team, reduces the risk of neurological complications.

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Successful Resuscitation of a Cardiac Arrest following Slit Neck and Carotid Artery Injury: A Case Report

Naqvi

Ali

Beg

et al. 2016

JCDR

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A 22-years-old male was brought to emergency of our hospital with history of alleged assault, with slaughtered neck from the left side with some sharp object. Cause of assault was not disclosed by the patient's attendants. On examination in hospital patient was in a state of cardiac arrest with laceration over the left lateral neck in the zone II with overlying large blood clot. An urgent call was send by casualty medical officer to vascular surgery unit. Cardio-pulmonary resuscitation was immediately started. Patient was intubated and chest compressions continued as the patient was rushed to emergency OT. Bilateral saphenous venous cut downs were done, fluid resuscitation started and injection adrenaline and soda bicarbonate was given intravenously. After 4-5 minutes of chest compression cardiac activity was observed on ECG and auscultation. Meanwhile neck exploration started by vascular surgery team showed active bleed from four different positions which were secured by applying vascular clamps and neck exploration started from proximal aspect. Intravenous unfractionated heparin was given. Skin incision was given anterior to sternocleidomastoid, platysma divided and carotid sheath identified. Sternocleidomastoid was divided for better and urgent visualization of carotid and internal jugular vein. Great vessels were identified and looped. Central venous catheter was inserted in internal jugular vein by open technique and inotropes and fluid management was started from central venous line. Patient had acceptable haemodynamic parameters by this time. Packed RBCs were arranged and transfused. Vascular repair was then started. Examination of wound, on applying clamps revealed transected superior thyroid artery, rent in internal carotid artery and transected external jugular vein. Superior pole of thyroid was actively bleeding. Trachea and oesophagus were intact. Right carotid and internal jugular vein were also found to be uninjured [Table /Fig-1].Superior thyroid artery and external jugular vein were ligated, internal carotid artery rent was repaired using prolene 6-0 and bleeding thyroid pole was ligated. After acceptable haemostasis sternocleidomastoid was repaired and wound closed inlayers [ Carotid artery injuries constitute a specific and relatively small group of vascular trauma among the traumatic injuries to neck. They have the potential of killing the patients within minutes to hours due to haemodynamic instability if not managed by the specialist team within time. Central Neurologic deficit from cerebral hypoxia either resulting primarily from trauma or secondarily from surgery is a major concern. We hereby present a case of a 22-year-old man who presented to emergency department with alleged assault and vascular trauma to neck in a state of cardiac arrest. On exploration patient had injuries to external and internal carotid arteries and external jugular vein. Combined effort of trauma team lead to successful resuscitation and saved the life of the patient.

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Karotisverletzungen

Cited by 3 publications

References 9 publications

Our Experiences In The Management Of Carotid Artery Injuries

Our Experiences In The Management Of Carotid Artery Injuries

Intraoperative Carotid Artery Injuries. Review of the literature, analysis of the material of one centre

Successful Resuscitation of a Cardiac Arrest following Slit Neck and Carotid Artery Injury: A Case Report

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