Management of acute cervicothoracic vascular injuries

One hundred eighty-one patients with 218 acute cervicothoracic vascular injuries underwent operations for diagnosis, resuscitation, and control of hemorrhage. The patients were divided into three clinical groups depending on their clinical status. Group I consisted of 105 patients who were hemodynamically stable and able to undergo diagnostic measures: Group II consisted of 41 patients who remained unstable and required immediate operation; Group III consisted of 35 patients who were moribund and underwent emergency room thoracotomy. The mortality rates were 4% for Group I, 15% for Group II, and 80% for Group III with an overall mortality rate of 21%. Angiography was performed in 53% of the stable Group I patients. This allowed specific identification of lesions such as arteriovenous fistula in eight patients and aortic disruption in 12 patients. Thirty-five Group III patients had thoracotomy performed in the emergency room and seven survived (20%). A vigorous clinical approach is recommended to minimize morbidity. A different approach is described for each of the three clinical groups of patients.