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Primary repair vs ligation for carotid artery injuries
Insights
Carotid artery repair is recommended for patients without coma and with stable vital signs. Prompt repair in these cases leads to good outcomes, minimizing stroke and mortality risks.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Neurology
Background:
- Carotid arterial injuries present significant morbidity and mortality risks.
- Optimal management strategies for these injuries require careful consideration of patient condition and injury severity.
Purpose of the Study:
- To retrospectively review the outcomes of carotid arterial injuries.
- To identify factors correlating with postoperative stroke and mortality.
- To establish recommendations for surgical repair versus ligation.
Main Methods:
- Retrospective review of 36 patients with carotid arterial injuries.
- Analysis of primary repair versus ligation outcomes.
- Correlation of preoperative neurological status and vital signs with postoperative results.
Main Results:
- Primary repair in 31 patients resulted in 9 strokes and 5 deaths.
- Ligation in 5 patients resulted in 3 strokes but no deaths.
- Preoperative neurological deficit, shock, and absent arterial flow were strong predictors of adverse outcomes.
- Patients with normal neurological status on admission had universally good outcomes post-repair.
Conclusions:
- Carotid artery repair is recommended for patients who are not comatose, have stable vital signs, and present with technically reparable injuries.
- Early neurological deficits and hemodynamic instability significantly increase the risk of postoperative stroke and mortality.
- Careful patient selection is crucial for optimizing outcomes following carotid artery injury management.
Abstract:
The morbidity and mortality of carotid arterial injuries in 36 patients were retrospectively reviewed. Primary repair was achieved in 31 patients; nine patients had a stroke postoperatively and five died. Five patients were treated with ligation; three had a stroke postoperatively, but all survived. Postoperative stroke and mortality correlated best with neurological deficit on administration. Patients in shock or with absent arterial flow were also more likely to have postoperative stroke. Twenty-two patients were normal neurologically on admission; all were normal postoperatively and all survived. Five patients were admitted unconscious in severe shock, precluding accurate neurological evaluation; two were normal following repair and three had stroke. Nine patients had a stroke or coma on admission; all nine had postoperative stroke and five died. Autopsy disclosed bilateral cerebral edema in two patients, cerebral edema and ipsilateral ischemic infarction in two patients, and cerebral edema with bilateral necrosis in one patient. No patient had hemorrhagic infarction. On the basis of these findings, carotid artery repair is recommended in all patients who are not comatose, have stable vital signs, and have technically reparable injuries.