Carotid artery injuries and their management

Background. Major vascular injuries in the region of the neck are most freq uently the result of penetrating trauma. Evaluation and management of patie nts with injury to Zone II of the neck remains highly controversial. Most s tudies involve small number of patients with a lack of standardization of t he nature of the injury in reporting outcome. It is the purpose of this stu dy to propose a grading scale for vascular injuries in the neck that would allow for more uniform reporting of such injuries. Methods. Experimental design: A retrospective review of all patients treate d for penetrating trauma to the neck was performed and the subset of patien ts with major vascular injuries identified. Data from this group of patient s are presented. Setting: Level II urban trauma center. Patients and interv entions: During the period July 1984 to June 1994, 107 patients were treate d for penetrating neck trauma. Injuries to the major arteries of the neck w ere present in 18 of the 107 patients (16.8%). All injuries were graded on the,developed scale, Management protocol was based on the grade of the inju ry. Grade 1 injuries were managed non-operatively with systemic anticoagula tion and low molecular weight dextran, Grade 2 injuries were treated with p rimary repair. Injuries of Grades 3 and ii were treated by primary repair o f interposition graft. Exceptions were isolated injuries of the external ca rotid artery, which were treated by ligation alone. Results. Of the 18 patients with carotid artery injuries, 2 had injuries of the external carotid artery, treated with Ligation alone. The internal car otid artery was injured in 7 cases. An interposition saphenous vein/PTFE gr aft was used in all cases, In 9 cases the common carotid artery was injured . Repair was accomplished by a combination of either a primary repair or in terposition graft. Overall mortality was 3/16 (16.6%). No new or worsening of neurologic deficit occurred in any patient. Conclusions. Carotid artery injuries occur in about 17% of patients with pe netrating neck trauma. Data regarding management and prognosis in these pat ients are at best conflicting, in part, due to lack of a standardized class ification system. The proposed grading scale is designed to overcome this p roblem.