Carotid artery trauma: management based on mechanism of injury.
Fifty-six patients with carotid injuries were reviewed (35 penetrating and 21 blunt). Shock correlated with a profound neurologic deficit on admission (p less than 0.03) in those with penetrating wounds. Thirty-one percent had primary repair, 25% had interposition grafting, 17% were ligated, and 17% were anticoagulated. Two graft failures resulted in death. Three blunt common carotid injuries followed direct cervical soft-tissue trauma; 18 internal carotid (ICA) dissections followed apparent extreme neck extension or flexion. Seven had bilateral ICA dissections (39%); none of these died. All dissections were diagnosed by angiography prompted by a change in the neurologic examination or an initial neurologic deficit unexplained by CT scan. Seventy-one percent had major associated injuries; 43% intra-abdominal solid viscus, 24% pelvis/long bone fractures, and 24% cervical spine/facial fractures. Dissections were treated with anticoagulation; 60% improved, 23% were unchanged, and 17% deteriorated. It is concluded that interposition grafting should be avoided if possible following penetrating wounds; liberal angiography is warranted with incompatible CT findings following blunt trauma; and anticoagulation is safe and effective therapy for blunt carotid dissections.
Fabian
T C
TC
Department of Surgery, Presley Regional Trauma Center, Memphis, Tennessee 38163.
George
S M
SM
Croce
M A
MA
Mangiante
E C
EC
Voeller
G R
GR
Kudsk
K A
KA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D020212:Carotid Artery Injuries; D002561:Cerebrovascular Disorders / Q000209:etiology; D005260:Female; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D014950:Wounds, Penetrating / Q000150:complications / Q000601:surgery / Q000628:therapy*
D000925:Anticoagulants