Blunt vascular injuries of the head and neck: Is heparinization necessary?

Background: Blunt vascular injuries to the head and neck (BHVI) represent s ome of the most devastating and morbid injuries seen by a trauma surgeon. T his series reviewed the experience of a single institution to determine if diagnostic and therapeutic guidelines can be established for these uncommon injuries. In particular, the utility of anticoagulation in the treatment o f these injuries is examined. Methods: The institutional trauma registry of a single state-designated Lev el I trauma center was examined for patients with BHVI, Patients were ident ified and their charts reviewed individually with regard to multiple data p oints including the type of injury, its presentation, the treatment of the injury, and the functional outcome of the patient. Results: Twenty-nine BHVI in 23 patients were reviewed from 1989 to 1997, N o mortalities were noted. Among the injuries noted were 14 internal carotid artery dissections and 8 carotid artery tears. Thirteen patients had accom panying closed head injuries. Ten patients were diagnosed after an abnormal neurologic examination, and eight others were diagnosed after having carot id canal fractures. Heparin was started within 48 hours of injury in 4 pati ents (17%) and was used in a total of 12 patients (52%), No patient worsene d neurologically after diagnosis independent of the use of heparin, Thirtee n patients (57%) had no or minimal deficits upon discharge. Conclusion: BHVI represent a serious cause of morbidity in the patient with multiple injuries. Patients with closed head injuries and carotid canal fr actures appear most at risk, A multicenter, randomized trial involving anti platelet therapy, full systemic anticoagulation, or observation with a long -term functional assessment is indicated to determine the optimal managemen t of these injuries.