Management and outcomes of wartime cervical carotid artery injury
| Autor: | Todd E. Rasmussen, Patrick F. Walker, Joseph D. Bozzay, Joseph M. White, Jigarkumar A. Patel, Paul W. White |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Carotid Artery Common External carotid artery Wounds Penetrating Critical Care and Intensive Care Medicine 03 medical and health sciences Young Adult 0302 clinical medicine Injury Severity Score Statistical significance medicine.artery Medicine Electronic Health Records Humans cardiovascular diseases Common carotid artery Military Medicine Stroke Iraq War 2003-2011 Ligation Afghan Campaign 2001 business.industry 030208 emergency & critical care medicine Retrospective cohort study medicine.disease United States Surgery Military Personnel Carotid Artery External cardiovascular system War-Related Injuries Internal carotid artery business Carotid Artery Injuries Carotid Artery Internal |
| Zdroj: | The journal of trauma and acute care surgery. 89(2S Suppl 2) |
| ISSN: | 2163-0763 |
| Popis: | Background Cervical carotid artery injuries entail high morbidity and mortality and are technically challenging to repair. This retrospective study describes the management and outcomes of cervical carotid injuries sustained during the recent wars in Iraq and Afghanistan. Methods The Department of Defense Trauma Registry was queried to identify US military personnel who sustained battle-related cervical carotid injury between January 2002 and December 2015. Retrospective chart reviews of the military Electronic Health Record were performed on patients identified. Demographics, injury characteristics, surgical management, and outcomes were reviewed. Statistical analysis was performed to identify associations between injury and management factors, as well as stroke and mortality. Results In total, 67 patients (100% male; age, 25 ± 7 years) were identified with cervical carotid artery injuries. Fifty-six patients (84%) sustained a common carotid artery (CCA) or internal carotid artery (ICA) injury, and 11 patients (16%) had an isolated external carotid artery (ECA) injury. The anatomic distribution of injury was as follows: CCA, 26 (38.8%); ICA, 24 (35.8%); CCA and ICA 2 (3%); ICA and ECA 3 (4.5%); and CCA, ICA, and ECA 1 (1.5%). Of the 56 CCA or ICA injuries, 39 underwent vascular repair, 9 (16%) were managed with ligation, 1 was treated with a temporary vascular shunt but succumbed to injuries before vascular repair, and 7 (13%) were treated nonoperatively. Seven (23%) of 30 ICA injuries were ligated compared with 2 (7.7%) of 26 injuries isolated to the CCA (p = 0.02). Compared with repair, ligation of the CCA/ICA was associated with a higher rate of stroke (89% vs. 33%, p = 0.003) and increased mortality without statistical significance (22% vs. 10%, p = 0.3). Every patient who underwent ICA ligation had a stroke (7/7). There was no difference in Injury Severity Score between the ligation and repair groups (23.8 ± 10.6 vs. 24.7 ± 13.4, p = 0.9). At a mean follow-up of 34.5 months, 10 of 17 stroke survivors had permanent neurologic deficits. Conclusion In modern combat, penetrating injuries involving the cervical carotid arteries are relatively infrequent. In this experience, isolated ICA injuries were three times more likely to be ligated than those involving the CCA. As a surgical maneuver, ICA ligation resulted in stroke in all cases. Level of evidence Retrospective cohort analysis, level III. |
| Databáze: | OpenAIRE |
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