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Combined carotid-vertebral arterial trauma
R J Landreneau1, J A Weigelt, S M Megison
1Division of Cardiothoracic Surgery, University of Missouri, Columbia.
Archives of Surgery (Chicago, Ill. : 1960)
|March 1, 1992
Summary
Simultaneous penetrating trauma to carotid and vertebral arteries is complex, leading to a 50% mortality rate. Early diagnosis via arteriography and extended anterior cervical surgical management are recommended for these critical injuries.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Cervical Arterial Injuries
Background:
- Penetrating injuries to cervical arteries are significant trauma events.
- Isolated carotid or vertebral trauma has a 10% mortality rate.
- Simultaneous injuries to both carotid and vertebral arteries represent a rare but severe subset.
Purpose of the Study:
- To analyze outcomes of patients with simultaneous penetrating trauma to carotid and vertebral arteries.
- To evaluate the effectiveness of diagnostic and surgical strategies for this complex injury pattern.
Main Methods:
- Retrospective review of eight patients with simultaneous carotid and vertebral arterial injuries over 14 years.
- Comparison of mortality rates with isolated arterial trauma.
- Assessment of the role of arteriography in diagnosis.
- Evaluation of surgical management through an extended anterior cervical approach.
Main Results:
- Eight patients with simultaneous injuries were identified among 129 carotid and 53 vertebral injuries.
- Mortality rate for this complex injury was 50%, significantly higher than isolated trauma.
- Arteriography proved valuable in diagnosing these complex injuries.
- The extended anterior cervical approach was utilized for simultaneous surgical management.
Conclusions:
- Simultaneous penetrating carotid and vertebral arterial trauma carries a high mortality (50%) due to injury complexity.
- Liberal use of arteriography aids in diagnosis.
- Simultaneous surgical management via an extended anterior cervical approach is recommended.