title: Management of arterial injury during endoscopic sinus and skull base surgery.
abstract: OBJECTIVE
  The most feared complication during endonasal surgery is a carotid artery injury. The sheep model of carotid injury provides training for this event by giving a realistic endoscopic experience of major vascular injuries and tissue hemostasis.
  
  
  RESULTS
  The sheep model of carotid artery injury recreates the narrow nasal confines and high-flow/high-pressure vascular injury accurately reproducing the endoscopic challenges seen in such vascular emergencies. This has led to the development of surgical techniques that quickly and effectively control the field of bleeding and achieve reliable hemostasis including the crushed muscle patch new direct vascular closure technologies. Vascular emergency simulation training is achieving better outcomes for our patients.
  
  
  CONCLUSIONS
  All skull base surgeons are at risk of the unexpected carotid artery injury and recently, the sheep model not only effectively recreates this situation but has identified clinically tried and tested techniques at managing this situation and is improving patient outcomes.
authors.affiliation: aDepartment of Surgery - Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide bDepartment of Surgery - Otorhinolaryngology, Head and Neck Surgery, The Queen Elizabeth Hospital, Woodville, Australia.
authors.forename: Rowan
authors.initials: R
authors.lastname: Valentine
authors.forename: Vikram
authors.initials: V
authors.lastname: Padhye
authors.forename: Peter-John
authors.initials: PJ
authors.lastname: Wormald
mesh_terms: D000818:Animals; D020212:Carotid Artery Injuries / Q000209:etiology*; D004195:Disease Models, Animal; D004724:Endoscopy / Q000009:adverse effects*; D006801:Humans; D007049:Iatrogenic Disease; D010256:Paranasal Sinuses / Q000098:blood supply* / Q000601:surgery*; D012756:Sheep; D019291:Skull Base / Q000098:blood supply* / Q000601:surgery*; D057772:Vascular System Injuries / Q000209:etiology*