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Cervical vessel injury after blunt trauma
S M Fakhry1, P F Jaques, H J Proctor
1University of North Carolina, School of Medicine, Dept. of Surgery, Chapel Hill 27599-7050.
Journal of Vascular Surgery
|October 1, 1988
Summary
Blunt trauma frequently causes serious cervical artery injuries, often delaying diagnosis and leading to poor outcomes. Early angiography and tailored treatments, including surgery or heparin, can improve results for these critical injuries.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Diagnostic Imaging
Background:
- Blunt trauma is a significant cause of cervical vessel injuries, with high rates of mortality and neurologic impairment.
- Injuries to the internal carotid artery (ICA) and vertebral artery can result from blunt force, leading to dissection, thrombosis, or pseudoaneurysm.
Purpose of the Study:
- To review recent experience with blunt cervical arterial injuries.
- To highlight diagnostic challenges and treatment strategies.
- To propose an angiographic classification for improved management.
Main Methods:
- Retrospective review of 10 patients with 18 blunt cervical arterial injuries.
- Analysis of diagnostic delays, initial patient presentation, and treatment modalities.
- Development of an angiographic classification system.
Main Results:
- Seven of 10 patients experienced diagnostic delays exceeding 12 hours.
- Common injuries included ICA dissections/thromboses and vertebral artery injuries.
- Individualized treatments ranged from supportive care and heparin to surgery and embolization.
Conclusions:
- Early diagnosis and intervention are crucial for improving outcomes in blunt cervical arterial injuries.
- Angiography is vital for patients with neurologic deficits incongruent with head CT scans or normal sensorium with hemiparesis.
- Direct operative repair is advocated for accessible, recent lesions, while heparin and close monitoring are options for others.