title: Management of traumatic vascular injuries to the neck: a 7-year experience at a Level I trauma center.
abstract: 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.
authors.affiliation: Division of Trauma and Surgical Critical Care, University of South Alabama, Mobile, Alabama 36617-2293, USA. drjonsimmons@gmail.com
authors.forename: Jon D
authors.initials: JD
authors.lastname: Simmons
authors.forename: Naveed
authors.initials: N
authors.lastname: Ahmed
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Donnellan
authors.forename: Robert E
authors.initials: RE
authors.lastname: Schmieg
authors.forename: John M
authors.initials: JM
authors.lastname: Porter
authors.forename: Marc E
authors.initials: ME
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D057510:Endovascular Procedures / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008922:Mississippi; D019838:Neck Injuries / Q000628:therapy*; D019035:Rural Health Services / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000706:statistics & numerical data*; D057772:Vascular System Injuries / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000628:therapy*; D014950:Wounds, Penetrating / Q000628:therapy*