TRAUMATIC VASCULAR DISRUPTION IN THE THORACOCERVICAL REGION - SURGICAL OUTCOME AND PREDICTORS OF SURVIVAL

Traumatic vascular injury in the thoracocervical region is associated with significant morbidity and mortality. The goal of this study was t o examine surgical outcome of these injuries and to establish predicto rs of survival. The medical records of all patients sustaining traumat ic injury to the carotid, vertebral, subclavian, and proximal axillary vessels and undergoing operative repair were retrospectively reviewed . Sixteen patients (11 men, 5 women, mean age 31.1 +/- 16.6) during a four-year period underwent emergent surgical repair for traumatic vasc ular disruption. There were 6 lesions of the carotid, 7 of the subclav ian, and 2 of the proximal axillary vessels and 1 vertebral artery inj ury. Sixty-two percent of the patients were hemodynamically unstable o n admission. In these patients the diagnosis was established by clinic al examination. Hemodynamically stable patients with a high index of s uspicion for vascular injury underwent urgent arteriography to confirm the diagnosis and assist in the operative approach. Surgical procedur es included lateral arteriorrhaphy (2), end-to-end anastomoses (2), sy nthetic interposition grafts (3), and autogenous vein graft (2). Seven patients underwent emergent ligation of the subclavian, carotid, or v ertebral artery. Despite 3 of 16 patients presenting in either unrespo nsive shock or with severe head trauma, overall mortality was 25%. Non survivors had significantly higher injury severity scores than survivo rs (36.3 +/- 13.1 vs 19.8 +/- 7.9, P < 0.05). Length of time from trau ma scene to hospital was a significant predictor of survival (33.4 +/- 13.3 vs 50.8 +/- 6.5 minutes) as was the presence of associated organ system injury (2.8 +/- 0.9 organ systems vs 4.3 +/- 0.9, P < 0.05) in survivors and nonsurvivors, respectively. No neurologic compromise or limb ischemia was noted in the group undergoing arterial ligation. Am ong similarly injured vessels, the type of surgical. repair did not in fluence patient survival. The outcome of surgical repair of a traumati c lesion of the thoracocervical vessels depends upon the rapid recogni tion of the injury, time delay to the trauma unit, and the magnitude o f associated injury.