[Management of carotid injuries]

The occurrence of carotid arterial injuries is relatively infrequent but have serious outcome. At the Department of Cardiovascular Surgery we have performed surgical interventions in 16 instances (7 penetrating and 9 blunt trauma patients) due to carotid injuries. Preoperatively all these patients developed neurological deficits and in the postoperative period 7 patients became asymptomatic. We lost two patients owing to stroke. Vascular injuries are generally characterized by hemorrhage and ischemia in the area supplied. In addition to the symptoms of hemorrhagic shock, penetrating vascular injuries may lead to embolism from the injured intimal surface, thrombus formation and subsequent occlusion may occur. In other instances pulsating hematomas can be formed and with combined arterial and venous trauma A-V fistula can develop. In blunt trauma patients stretching or compression of the vessel may cause intimal rupture with subsequent formation of subintimal hematoma, dissection and later pseudoaneurysm. The disruption of the atherosclerotic plaque or the accumulation on the injured intimal surface may serve as source of embolism and thrombosis. In symptomatic patients the urgent performance of the surgical correction of the carotid arterial injuries is mandatory, nevertheless in asymptomatic patients and in chronic cases the prevention of the late complications is also justified as soon as possible.