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Published on: January 23, 2019
Interdisciplinary Successful Revascularization of Traumatic Occlusion of the Right Common Carotid Artery
Boris Ilchev1, Vasil Chervenkov1, Nikolay Valchev1
1Department of Vascular Surgery, Acibadem City Clinic University Hospital Tokuda, Sofia, BGR.
Insights
Blunt carotid artery injury (BCI) is a rare but serious condition. Surgical repair of a completely occluded carotid artery in a trauma patient restored blood flow and improved brain perfusion.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Neurology
Background:
- Blunt carotid artery injury (BCI) is a rare but severe complication of blunt trauma.
- BCI can lead to significant neurological deficits, morbidity, and mortality.
Observation:
- A 33-year-old male presented with complete thrombotic occlusion of the right common carotid artery (CCA) after a workplace accident.
- The patient exhibited profound neurological deficits, necessitating urgent surgical intervention.
Findings:
- Surgical exploration revealed extensive arterial damage, requiring thrombectomy and primary repair with saphenous vein patch angioplasty.
- Postoperative recovery was successful, with restored pulsatile blood flow confirmed by Doppler ultrasound.
- Three-month follow-up showed a patent arterial reconstruction and improved cerebral perfusion, despite residual neurological deficits.
Implications:
- This case highlights the challenges in diagnosing and managing BCI, emphasizing a tailored approach based on injury severity and neurological status.
- Surgical intervention is a viable option for select BCI cases, particularly those with complete occlusion and neurological compromise.
- Long-term surveillance is crucial for assessing reconstruction durability and monitoring for thromboembolic events.
Abstract:
Blunt carotid artery injury (BCI) poses a rare yet severe threat following vascular trauma, often leading to significant morbidity and mortality. We present a case of a 33-year-old male who suffered complete thrombotic occlusion of the right common carotid artery (CCA) following a workplace accident. Clinical evaluation revealed profound neurological deficits, prompting multidisciplinary surgical intervention guided by the Denver criteria (Grade I - disruption inside the vessel that results in a narrowing of the lumen by less than 25%; Grade II - dissection or intramural hematoma causing greater than 25% stenosis; Grade III - comprises pseudoaneurysm formation; Grade IV - causes total vessel occlusion; Grade V - describes vessel transection with extravasation). Surgical exploration unveiled extensive arterial damage, necessitating thrombectomy, primary repair, and double-layered patch angioplasty using an autologous saphenous vein. Postoperative recovery was uneventful, with the restoration of pulsatile blood flow confirmed by Doppler ultrasound. Three-month follow-up demonstrated patent arterial reconstruction and improved cerebral perfusion, despite the persistent neurological deficits. Our case underscores the challenges in diagnosing and managing BCI, advocating for a tailored approach based on injury severity and neurological status. While conservative management remains standard, surgical intervention offers a viable option in select cases, particularly those with complete vessel occlusion and neurological compromise. Long-term surveillance is imperative to assess the durability of arterial reconstruction and monitor for recurrent thromboembolic events. Further research is warranted to refine management algorithms and elucidate optimal treatment strategies in this rare but critical vascular pathology.
