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Successful repair of bilateral common carotid artery dissections from hanging
Manuela Aspalter1, Klaus Linni, Christoph M Domenig
1Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria.
Insights
Blunt carotid artery dissections from strangulation are challenging. Surgical repair using saphenous vein grafts led to independent recovery in two patients with near-hanging injuries.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Forensic Medicine
Background:
- Management of blunt carotid artery dissections (BCAD) from nonfatal strangulation is controversial.
- Diagnostic work-up and treatment strategies for BCAD require further clarification.
Observation:
- Two male patients (49 and 41 years old) presented with bilateral common carotid artery dissection secondary to strangulation.
- One patient had associated cricotracheal separation and blunt thyroid gland trauma.
Findings:
- Both patients underwent bilateral saphenous vein graft interposition for carotid artery repair.
- The first patient also required tracheal repair and thyroid gland suture.
- At 1-year follow-up, both patients achieved independent living.
Implications:
- Surgical intervention with vascular grafting can be effective for BCAD from strangulation.
- This case series, supplemented by a literature review, offers insights into managing near-hanging and strangulation victims.
- Further research is warranted to establish definitive management guidelines for these rare injuries.
Abstract:
The management of blunt carotid artery dissections caused by hanging remains controversial, especially with regard to diagnostic work-up and treatment options. We present 2 men, 49 and 41 years of age, who were treated for bilateral common carotid artery dissection caused by strangulation. In the first patient, additional cricotracheal separation and blunt thyroid gland trauma was observed. Bilateral saphenous vein graft interposition was accomplished in both patients. In the first patient, tracheal repair and suture of the thyroid gland completed the procedure. At 1 year of follow-up, both patients were capable of managing their lives independently. A systematic review of the literature on managing near-hanging and nonfatal strangulation victims is included in this report to allow this case series to be put into perspective.
