Document Detail


Neurologic outcome after penetrating extracranial arterial trauma.
MedLine Citation:
PMID:  12891106     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: We undertook this study to determine factors that adversely affect outcome in patients with penetrating injury to the extracranial cerebral vasculature. Patients and methods Medical records were reviewed for all patients who had undergone surgical intervention to treat penetrating injury to the extracranial cerebral arteries between January 1989 and December 1999. Forensic autopsy findings were also reviewed for all patients who died as a result of their injury.
RESULTS: One hundred fifty-one patients with injury to the brachiocephalic artery (n = 21), common carotid artery (n = 98), or internal carotid artery (n = 32) were identified. Overall mortality was 21.2%, and stroke rate in surviving patients was 15.1%. Twenty-five of 32 deaths (78.1%) were stroke-related. Brachiocephalic artery injury was associated with the highest mortality (38.1%), and survivor stroke rate was highest in patients with internal carotid injuries (22.7%). Hemodynamic instability at presentation led to both higher mortality (30.7%) and stroke rate (19.2%). Preoperative angiography did not influence mortality or stroke rate in hemodynamically stable patients. Procedural mortality associated with arterial ligation was 45% (9 of 20 patients), and no surviving patient experienced a change in pre-ligation neurologic state. Nine patients remained neurologically intact after ligation, and 2 patients with preoperative localized neurologic deficit were unchanged postoperatively. In 131 patients, mortality after arterial repair was 17.6%, and in 5 surviving patients (5.4%) an ischemic neurologic deficit developed. Twelve of 15 surviving patients (80%) with preoperative neurologic deficit who underwent arterial repair had improved neurologic status. Cerebral infarcts were confirmed at autopsy in 23 patients; 18 infarcts were ischemic (10, repair; 8, ligation), and 5 infarcts were hemorrhagic (all, repair). No factor was identified that was predictive of ischemic versus hemorrhagic infarction in patients undergoing repair.
CONCLUSIONS: The presence of hypovolemic shock, internal carotid artery injury, complete vessel transection, and arterial ligation are associated with unfavorable outcome. Penetrating injury to the brachiocephalic, common carotid, or internal carotid artery should be repaired rather than ligated when technically possible. Subsequent ischemic or hemorrhagic cerebral infarction is unpredictable, but overall outcome is superior to that with ligation of the injured artery.
Authors:
Daniel F du Toit; Gerrit D van Schalkwyk; Shabbir A Wadee; Brian L Warren
Related Documents :
18959806 - Blunt injury to the inferior gluteal artery: case report of a rare "near miss" event.
9033346 - Complex thoracic vascular injury repair using deep hypothermia and circulatory arrest.
15288636 - Evaluation of flow hemodynamics by color-doppler following two different brachial arter...
8470266 - Atherosclerosis: current understanding of mechanisms and future strategies in therapy.
9412636 - Cerebrovascular reserve capacity many years after vasospasm due to aneurysmal subarachn...
17536116 - Management of pulmonary hypertension in the operating room.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  38     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-07-31     Completed Date:  2003-09-04     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  257-62     Citation Subset:  IM    
Affiliation:
Department of Surgery, Tygerberg Hospital, PO Box 19063, Tygerberg 7505, South Africa. ddt@sun.ac.za
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Brachiocephalic Trunk / injuries*,  surgery
Carotid Artery Injuries / complications*,  surgery
Cerebral Infarction / etiology*
Female
Humans
Male
Middle Aged
Nervous System Diseases / etiology
Retrospective Studies
Wounds, Penetrating / complications*,  surgery

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


Previous Document:  Postoperative infection associated with polyester patch angioplasty after carotid endarterectomy.
Next Document:  Percutaneous arterial closure in peripheral vascular disease: a prospective randomized evaluation of...