Document Detail


Management of penetrating injuries to carotid artery.
MedLine Citation:
PMID:  11571968     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The diagnosis and management of penetrating injuries to the cervical carotid arteries continue to be controversial. Most patients with stab or gunshot wounds to the common or internal carotid artery in cervical zone II (sternal notch to angle of mandible) are symptomatic with external or intraoral hemorrhage, a rapidly expanding hematoma, evidence of a carotid-jugular arteriovenous fistula at an obvious site, or loss of the carotid pulse with a neurologic deficit. Immediate airway control and arterial repair are indicated in such patients. Other patients present with stab or gunshot wounds with proximity only to the carotid sheath, a stable hematoma, unknown level of a carotid-jugular arteriovenous fistula, or loss of the carotid pulse without a neurologic deficit. Diagnostic options in this latter group include duplex ultrasound, color duplex imaging, and standard arteriography, while the role of CT or MRI angiography in evaluating patients with penetrating cervical wounds is unclear at this time. Certain arterial injuries discovered on diagnostic tests are currently managed with observation, endovascular stenting (for intimal or wall irregularities), and arteriographic embolization (for small pseudoaneurysms or high carotid-jugular fistulas). Operative repairs for injuries in zone II are performed through an oblique cervical incision and include all the options used with peripheral vascular injuries. Patients with penetrating cervical wounds, preoperative neurologic deficits, and immediate transport to the trauma center should have repair rather than ligation of the injured carotid artery. When the patient is truly comatose with a Glasgow Coma Scale score < 8, an unsatisfactory neurologic outcome is likely with either arterial repair or ligation. Injuries to the extracranial internal carotid artery in cervical zone III (above the angle of the mandible) may require innovative approaches to control hemorrhage and then maintain flow to the ipsilateral cerebral cortex.
Authors:
D V Feliciano
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  World journal of surgery     Volume:  25     ISSN:  0364-2313     ISO Abbreviation:  World J Surg     Publication Date:  2001 Aug 
Date Detail:
Created Date:  2001-09-26     Completed Date:  2002-07-16     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1028-35     Citation Subset:  IM    
Affiliation:
Grady Memorial Hospital, Emory University School of Medicine, 69 Butler Street, Suite 301, Atlanta, Georgia 30303, USA.
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MeSH Terms
Descriptor/Qualifier:
Carotid Artery Injuries / complications,  surgery*
Hemorrhage / etiology,  surgery
Humans
Wounds, Penetrating / surgery*
Comments/Corrections
Erratum In:
World J Surg 2002 Feb;26(2):284

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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