Management of Penetrating Cervicomediastinal Venous Trauma

Abstract

ligation is an acceptable form of treatment of cervicomediastinal venous injuries in the presence of haemodynamic instability, or where complex methods of repair would otherwise be necessary.

Transverse Sinus Thrombosis After Internal Jugular Vein Ligation

“…Current consensus favors immediate ligation of the internal jugular vein in the unstable patient or when major hemorrhage needs to be controlled (19 -22). Nair et al reviewed a series of 25 patients with internal jugular injuries and found ligation to be a safe option without any significant sequelae (20). There is a role for repair of internal jugular injury, but this should be done only in the stable patient or when the jugular veins are injured bilaterally (20,21).…”

“…Nair et al reviewed a series of 25 patients with internal jugular injuries and found ligation to be a safe option without any significant sequelae (20). There is a role for repair of internal jugular injury, but this should be done only in the stable patient or when the jugular veins are injured bilaterally (20,21). Venous repair has a high propensity for thrombosis, even with use of adjuvant therapies including heparinization and antiplatelet agents (21).…”

“…Venous repair has a high propensity for thrombosis, even with use of adjuvant therapies including heparinization and antiplatelet agents (21). Therefore, if complex techniques are required to repair the vein, such as interposition grafting, patch angioplasty, or resection and reanastomosis, ligation should be the preferred option for repair (20). Recent reports also describe occlusion of the vein by endovascular methods after surgical control of the bleeding (22).…”

Two-Stage Reconstruction of the Superior Vena Cava After Gunshot to the Chest

“…Damage control ligation may be needed in hemodynamically unstable patients. 16 Robbs and Reddy 17 have reported successful ligation of the subclavian and internal jugular veins in several patients with penetrating injuries, and a single case of SVC ligation. However, ligation of the SVC is not the best management option, because it usually results in severe cerebral and upper extremity edema.…”

Shrapnel superior vena cava injury: Case report

“…The true incidence of penetrating wounds of the SVC as well as other great vessels is not known since many of these patients succumb shortly after injury and autopsy examination is not done in all patients dying after trauma [3]. Little has been written about cervicomediastinal venous injury [4]. We searched the English medical literature on the net; we obtained sporadic case reports of penetrating SVC injuries caused by stab wounds or gunshots but no case of SVC shrapnel injury was found.…”