Vascular Trauma: Neck and Chest

Vascular Trauma: Neck and Chest

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Carotid, Vertebral and Subclavian Vessels


Carotid and subclavian artery injuries (blunt or penetrating) account for less than 2% of vascular trauma, but carry a high mortality and morbidity. The neck is divided into three distinct anatomical zones but more than one zone may be involved.


All patients should be managed initially as per the advanced trauma life support (ATLS) guidelines. Blunt injury is associated with multiple competing injuries requiring treatment. If the patient is physiologically well, then a CT with contrast (arterial and portal venous phase) is the investigation of choice.


Blunt Carotid Trauma


These carry a high mortality and stroke rate and are associated with a high incidence of c-spine and head injuries (contributing to the high mortality and morbidity). Often the neurological injury has already occurred by the time of presentation (head trauma or embolic stroke).


Management



  • Surgery has not been shown to alter either the mortality or stroke rates although free haemorrhage should undergo surgical control.
  • Anticoagulation (heparin or LMWH) has been shown to improve both mortality and stroke outcomes. However, this is often contraindicated in trauma (especially head injury).
  • Angiointervention may be used but its role has not been well scrutinised to date.
  • A post-hanging carotid injury with intimal tear (although a blunt injury) should be repaired if grade II or greater. A grade I injury may be treated with antiplatelet therapy (e.g. aspirin).

Penetrating Carotid Trauma


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Jul 1, 2016 | Posted by in CARDIOLOGY | Comments Off on Vascular Trauma: Neck and Chest

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