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Madsen AS, Kruger D, Clarke DL, Navsaria P, Scriba M, Bekker W, Moeng MS. Outcomes of penetrating carotid artery injuries: A South African multicentre study. World J Surg 2024; 48:1848-1862. [PMID: 38922735 DOI: 10.1002/wjs.12252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 06/02/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND This multicenter study examines the contemporary management of penetrating carotid artery injury (PCAI) to identify trends in management, outcomes, and to determine prognostic factors for stroke and death. METHODS Data from three large urban trauma centers in South Africa were retrospectively reviewed for patients who presented with PCAI from 2012 to 2020. RESULTS Of 149 identified patients, 137 actively managed patients were included. Twenty-four patients (17.9%) presented in coma and 12 (9.0%) with localizing signs (LS). CT angiography was performed on admission for 120 (87.6%) patients. Thirty patients (21.9%) underwent nonoperative management, 87 (63.5%) open surgery, and 20 (14.6%) endovascular stenting. Eighteen patients (13.1%) died, and 15 (12.6%) surviving patients had strokes. Ligation was significantly related to death and reperfusion to survival. A mechanism of gunshot wound, occlusive injuries, a threatened airway, a systolic blood pressure <90 mmHg, hard signs of vascular injury, a low GCS, coma, a CT brain demonstrating infarct, a high injury severity score and shock index, a low pH or HCO3, and an elevated lactate were significant independent prognostic factors for death. Ligation was unsurvivable in all patients with severe neurological deficits, whereas reperfusion procedures resulted in survival in 63% (12/19) patients with coma and 78% (7/9) with LS although with high stroke rates (coma: 25.0%, LS: 85.7%). CONCLUSIONS Outcomes in PCAI, including patients with severe neurological deficit and stroke, are better when reperfused. Reperfusion holds the best promise of survival and ligation should be reserved for technically inaccessible bleeding injuries.
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Affiliation(s)
- Andre Steiner Madsen
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Deirdre Kruger
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Damian Luiz Clarke
- Department of Surgery Pietermaritzburg, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Pradeep Navsaria
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Matthias Scriba
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Wanda Bekker
- Department of Surgery Pietermaritzburg, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Maeyane Steve Moeng
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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2
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Ng DCY, Lim KT. Use of a Sengstaken-Blakemore tube in a lifesaving non-variceal oesophageal bleed from pseudoaneurysms of the superior and inferior thyroid arteries. BMJ Case Rep 2024; 17:e256539. [PMID: 38901849 DOI: 10.1136/bcr-2023-256539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024] Open
Affiliation(s)
| | - Kheng Tian Lim
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
- Department of Surgery, Gladstone Hospital, Gladstone, Queensland, Australia
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3
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Sundaram DS, Lal B, Kumar RD, Bhutia O. A rare case of bilateral pseudoaneurysm secondary to mandibular condyle fracture-a case report with review of literature. Oral Maxillofac Surg 2023; 27:527-532. [PMID: 35654988 DOI: 10.1007/s10006-022-01069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/01/2022] [Indexed: 11/28/2022]
Abstract
This paper aims to present a rare case report of bilateral pseudoaneurysm secondary to condylar fracture and its management with a brief review of literature. A patient of age 19 years with alleged history of road traffic accident presented 6 weeks lately to our department with slow growing swelling in right preauricular area. History revealed bilateral condylar fracture with right parasymphysis fracture of mandible for which patient underwent maxillomandibular fixation for 4 weeks. The diffuse swelling in preauricular region showed positive signs of pulsation and audible bruit. Ultrasonography and contrast-enhanced computed tomography suggested the bilateral presence of vascular anamoly from the terminal branches of external carotid artery. Diagnostic angiography confirmed presence of pseudoaneurysm at the bifurcation of the internal maxillary artery and superficial temporal artery (STA) on right side whereas on the left side it was at proximal STA. Bilateral endovascular coil and gel foam embolization was done and thrombosis was confirmed with high frequency ultrasound on fourth postintervention day. The swelling completely resolved in a period of 1 month with no evidence of recurrence in the following 2-year follow-up period. Routine investigation revealed presence of pseudoaneurysm on left side which was completely without any clinical signs as repoterd by many cases of condylar fracture in the literature review. Pseudoaneurysm may remain silent and are exposed intraoperatively with massive bleeding which causes significant morbidity. Hence, prompt diagnosis and management is essential to avoid unexpected complication perioperatively.
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Affiliation(s)
- D Shanmuga Sundaram
- Department of Oral and Maxillofacial Surgery, All India Institue of Medical Sciences, New Delhi-110029, India
| | - Babu Lal
- Department of Oral and Maxillofacial Surgery, All India Institue of Medical Sciences, New Delhi-110029, India
| | - Rudra Deo Kumar
- Department of Oral and Maxillofacial Surgery, All India Institue of Medical Sciences, New Delhi-110029, India
| | - Ongkila Bhutia
- Department of Oral and Maxillofacial Surgery, All India Institue of Medical Sciences, New Delhi-110029, India.
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4
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Badalamenti G, Ferrer C, Calvagna C, Franchin M, Piffaretti G, Taglialavoro J, Bassini S, Griselli F, Grando B, Lepidi S, D'Oria M. Major vascular traumas to the neck, upper limbs, and chest: Clinical presentation, diagnostic approach, and management strategies. Semin Vasc Surg 2023; 36:258-267. [PMID: 37330239 DOI: 10.1053/j.semvascsurg.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 06/19/2023]
Abstract
Major vascular traumas to the neck, upper limbs, and chest may arise from penetrating and/or blunt mechanisms, resulting in a range of clinical scenarios. Lesions to the carotid arteries may also lead to neurologic complications, such as stroke. The increasing use of invasive arterial access for diagnostic and/or interventional purposes has increased the rate of iatrogenic injuries, which usually occur in older and hospitalized patients. Bleeding control and restoration of perfusion represent the two main goals of treatment for vascular traumatic lesions. Open surgery still represents the gold standard for most lesions, although endovascular approaches have increasingly emerged as feasible and effective options, particularly for management of subclavian and aortic injuries. In addition to advanced imaging (including ultrasound, contrast-enhanced cross-sectional imaging, and arteriography) and life support measures, multidisciplinary care is required, particularly in the setting of concomitant injuries to the bones, soft tissues, or other vital organs. Modern vascular surgeons should be familiar with the whole armamentarium of open and endovascular techniques needed to manage major vascular traumas safely and promptly.
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Affiliation(s)
- Giovanni Badalamenti
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Ciro Ferrer
- Vascular and Endovascular Surgery Unit, 90352 San Giovanni - Addolorata Hospital, Roma, Italy
| | - Cristiano Calvagna
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Marco Franchin
- Vascular Surgery Unit, Circolo University Teaching Hospital, University of Insubria - ASST Settelaghi, Varese, Italy
| | - Gabriele Piffaretti
- Vascular Surgery Unit, Circolo University Teaching Hospital, University of Insubria - ASST Settelaghi, Varese, Italy
| | - Jacopo Taglialavoro
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Silvia Bassini
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Filippo Griselli
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Beatrice Grando
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy.
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5
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Pseudoaneurysms and Orthognathic Surgery: A Systematic Review and a Proposed Algorithm of Treatment. J Craniofac Surg 2022; 34:1031-1035. [PMID: 36377043 DOI: 10.1097/scs.0000000000009134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to gather existing evidence regarding the incidence, clinical presentation, and management of pseudoaneurysms (PA) after orthognathic surgery, identify the common blood vessels involved in PA, and propose a treatment algorithm based on current evidence. The protocol for this study was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols and was registered at the International Prospective Register of Systematic Reviews under the registration number CRD42020205479. Although these are rare, oral and maxillofacial surgeons should consider PA as a possible diagnosis, specifically in the maxillary artery of patients with epistaxis, severe facial edema, and swelling following LeFort I osteotomy.
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6
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Maiese A, Frati P, Manetti AC, De Matteis A, Di Paolo M, La Russa R, Turillazzi E, Frati A, Fineschi V. Traumatic Internal Carotid Artery Injuries: Do We Need a Screening Strategy? Literature Review, Case Report, and Forensic Evaluation. Curr Neuropharmacol 2022; 20:1752-1773. [PMID: 34254918 PMCID: PMC9881067 DOI: 10.2174/1570159x19666210712125929] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/05/2021] [Accepted: 06/01/2021] [Indexed: 11/22/2022] Open
Abstract
Internal carotid artery dissection (ICAD) represents the cause of ictus cerebri in about 20% of all cases of cerebral infarction among the young adult population. ICAD could involve the extracranial and intracranial internal carotid artery (ICA). It could be spontaneous (SICAD) or traumatic (TICAD). It has been estimated that carotid injuries could complicate the 0,32% of cases of general blunt trauma and the percentage seems to be higher in cases of severe multiple traumas. TICAD is diagnosed when neurological symptoms have already occurred, and it could have devastating consequences, from permanent neurological impairment to death. Thus, even if it is a rare condition, a prompt diagnosis is essential. There are no specific guidelines regarding TICAD screening. Nevertheless, TICAD should be taken into consideration when a young adult or middle-aged patient presents after severe blunt trauma. Understanding which kind of traumatic event is most associated with TICAD could help clinicians to direct their diagnostic process. Herein, a review of the literature concerning TICAD has been carried out to highlight its correlation with specific traumatic events. TICAD is mostly correlated to motor vehicle accidents (94/227), specifically to car accidents (39/94), and to direct or indirect head and cervical trauma (76/227). As well, a case report is presented to discuss TICAD forensic implications.
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Affiliation(s)
- Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy; ,IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy;
| | - Paola Frati
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy;
| | - Alice Chiara Manetti
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy;
| | - Alessandra De Matteis
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy;
| | - Marco Di Paolo
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy;
| | - Raffaele La Russa
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy;
| | - Emanuela Turillazzi
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy;
| | - Alessandro Frati
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Neurosurgery Division, Human Neurosciences Department, Sapienza University of Rome, Rome, Italy
| | - Vittorio Fineschi
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy; ,Address correspondence to this author at the Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy; E-mail:
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7
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Serna JJ, Ordoñez CA, Parra MW, Serna C, Caicedo Y, Rosero A, Velásquez F, Serna C, Salcedo A, González-Hadad A, García A, Herrera MA, Pino LF, Franco MJ, Rodríguez-Holguín F. Damage control in penetrating carotid artery trauma: changing a 100-year paradigm. Colomb Med (Cali) 2021; 52:e4054807. [PMID: 34908620 PMCID: PMC8634279 DOI: 10.25100/cm.v52i2.4807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/30/2021] [Accepted: 06/09/2021] [Indexed: 11/11/2022] Open
Abstract
Carotid artery trauma carries a high risk of neurological sequelae and death. Surgical management of these injuries has been controversial because it entails deciding between repair or ligation of the vessel, for which there is still no true consensus either way. This article proposes a new management strategy for carotid artery injuries based on the principles of damage control surgery which include endovascular and/or traditional open repair techniques. The decision to operate immediately or to perform further imaging studies will depend on the patient's hemodynamic status. If the patient presents with massive bleeding, an expanding neck hematoma or refractory hypovolemic shock, urgent surgical intervention is indicated. An altered mental status upon arrival is a potentially poor prognosis marker and should be taken into account in the therapeutic decision-making. We describe a step-by-step algorithmic approach to these injuries, including open and endovascular techniques. In addition, conservative non-operative management has also been included as a potentially viable strategy in selected patients, which avoids unnecessary surgery in many cases.
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Affiliation(s)
- José Julián Serna
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Carlos A Ordoñez
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale FL , USA
| | - Carlos Serna
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
| | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Alberto Rosero
- Fundación Valle del Lili, Department of Radiology, Division of Neuroradiology, Cali, Colombia
| | | | - Carlos Serna
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
| | - Alexander Salcedo
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Adolfo González-Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
| | - Alberto García
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Maria Josefa Franco
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
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8
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Cheraghali R, Salimi J, Omrani Z. Endovascular treatment of penetrating vascular injuries. J Surg Case Rep 2021; 2021:rjab486. [PMID: 34804479 PMCID: PMC8599047 DOI: 10.1093/jscr/rjab486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/05/2021] [Indexed: 11/14/2022] Open
Abstract
Endovascular treatment of vascular injuries has resulted in reduced operating time, blood loss, hospital mortality and sepsis. The purpose of this study was to evaluate the success and complication rate of the endovascular management of penetrating peripheral vascular injuries during 5 years. In this observational study, the clinical records and imaging features of 22 penetrating trauma injuries of 276 penetrating vascular trauma patients (8%), which were repaired using endovascular stent-grafts or coil embolization, between April 2013 and August 2018, included in the study. The median age of patients was 43 years (Range, 20–78 years). There were 17 stab wounds (77.3%), 2 shotgun war remnants (9.1%) and 2 iatrogenic post-surgical lesions. Eleven stent-grafts (50%) and nine coil embolizations (40.9%) were deployed. Endovascular interventions in the management of peripheral vascular injuries can be efficient in definitive repair, damage control and hemorrhage control in severely ill trauma patients.
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Affiliation(s)
- Roozbeh Cheraghali
- Vascular and Endovascular Surgery, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Javad Salimi
- Vascular and Endovascular Surgery, Liver Transplantation Program, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Omrani
- Department of Surgery, Iran University of Medical Sciences (IUMS), Tehran, Iran
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9
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Serna-Arbeláez CA, Saldarriaga L, Folleco E, Rosero AL, Caicedo Y, Timaran SD, Serna JJ, García A, Rodríguez-Holguín F, Ordoñez Delgado CA. La nueva realidad: Manejo endovascular del trauma de carótida. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La mayoría de las lesiones de carótida cervical en nuestra institución se manejan por vía endovascular. El objetivo de este estudio fue describir los desenlaces del manejo de las lesiones de carótida cervical en un hospital de cuarto nivel en la ciudad de Cali, Colombia.
Métodos. Estudio de series de casos, retrospectivo, descriptivo, en pacientes con trauma de carótida (penetrante y cerrado), admitidos en un centro de alta complejidad de la ciudad de Cali, en el periodo comprendido desde enero de 2018 hasta enero de 2020.
Resultados. Se evaluaron 20 pacientes con lesión de carótida, de los cuales 90 % tenía trauma penetrante, en su mayoría por proyectil de arma de fuego. La zona más frecuentemente afectada fue la carótida interna (65 %) y el 40 % de los pacientes presentaban síntomas neurológicos al ingreso. Se realizó manejo endovascular en 13 pacientes, con un 75 % de éxito en el manejo endovascular al ingreso. La mortalidad general fue del 20 %, que en su mayoría estuvo relacionada con traumatismo en otros órganos. El 69 % de los pacientes quedaron sin secuelas neurológicas al alta y el 25 % con secuelas mínimas.
Discusión. Se muestra una serie de casos con lesión de carótida donde, teniendo en cuenta las variables de mal pronóstico para hacer una selección adecuada de los pacientes candidatos a este tipo de terapia, el resultado del manejo endovascular fue exitoso.
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10
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Post-traumatic pseudoaneurysm of the left posterior ear artery. ANGIOLOGIA 2021. [DOI: 10.20960/angiologia.00281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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11
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Jenkins LN, Rezende-Neto JB. Current Management of Penetrating Traumatic Cervical Vascular Injuries. CURRENT SURGERY REPORTS 2020. [DOI: 10.1007/s40137-020-00258-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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12
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Brzezicki G, Meyer TE, Madbak F, Widrich J, Jensen A. Nail Gun Injury and Endovascular Repair of Cervical Internal Carotid Artery. Cureus 2019; 11:e4237. [PMID: 31131161 PMCID: PMC6516626 DOI: 10.7759/cureus.4237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A male patient aged 49 years presented to the emergency room after sustaining a nail-gun injury to the left neck (Zone III). Computed tomography (CT) angiogram demonstrated retained nail traversing in close proximity to the left internal carotid artery. Catheter angiogram with three-dimensional (3D) reconstruction revealed partial left internal carotid injury without active extravasation and with preserved flow through the vessel. The nail was removed by gentle traction with the simultaneous deployment of stent-graft across the injured segment. Balloon angioplasty of the stent was performed secondary to endoleak and active extravasation. Complete vessel reconstruction with maintained blood flow was achieved. The patient was extubated the following day and was discharged home on hospital day five without neurological deficits. This case report demonstrates the usefulness of endovascular repair of high cervical arterial injuries with special attention to the unique nature of nail gun injuries.
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Affiliation(s)
- Grzegorz Brzezicki
- Neurosurgery, University of Florida College of Medicine, Jacksonville, USA
| | - Travis E Meyer
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Firas Madbak
- Surgery, University of Florida College of Medicine, Jacksonville, USA
| | - Jason Widrich
- Anesthesiology, University of Florida College of Medicine, Jacksonville, USA
| | - Abbie Jensen
- Surgery, University of Florida College of Medicine, Jacksonville, USA
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14
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Deib G, El Mekabaty A, Gailloud P, Pearl MS. Treatment of hemorrhagic head and neck lesions by direct puncture and n-BCA embolization. J Neurointerv Surg 2018; 10:e25. [PMID: 29627788 DOI: 10.1136/neurintsurg-2017-013335.rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/18/2017] [Accepted: 08/26/2017] [Indexed: 11/04/2022]
Abstract
Life-threatening bleeding in the head and neck region requires urgent management. These hemorrhagic lesions, for example, a ruptured pseudoaneurysm, are often treated by transarterial embolization (TAE), but prior intervention or surgery, inflammation, anatomic variants, and vessel tortuosity may render an endovascular approach challenging, time-consuming, and sometimes impossible. We report two cases of severe head and neck hemorrhages successfully embolized with n-butyl cyanoacrylate via direct puncture, and propose this approach as a fast, safe, and effective alternative to TAE.
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Affiliation(s)
- Gerard Deib
- Division of Interventional Neuroradiology, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Amgad El Mekabaty
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Philippe Gailloud
- Division of Interventional Neuroradiology, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Monica Smith Pearl
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Department of Radiology, Children's National Medical Center, District of Columbia, USA
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15
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Moro A, Todaro M, Pedicelli A, Alexandre A, Pelo S, Doneddu P, Gasparini G, Garagiola U, D’Amato G, Saponaro G. Pseudoaneurysm of the internal maxillary artery secondary to subcondylar fracture: case report and literature review. J Surg Case Rep 2018; 2018:rjy080. [PMID: 29713448 PMCID: PMC5915943 DOI: 10.1093/jscr/rjy080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/14/2018] [Indexed: 11/30/2022] Open
Abstract
Pseudoaneurysms are an uncommon complication of mandibular condylar-subcondylar fractures; however, if present, their recognition and management is mandatory to avoid life-threatening situations. The authors report a case of internal maxillary artery pseudoaneurysm rupture that occurred after an open reduction and internal fixation of a mandibular subcondylar fracture, along with a review of the literature.
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Affiliation(s)
- Alessandro Moro
- Maxillo-Facial Unit, University Hospital ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
| | - Mattia Todaro
- Maxillo-Facial Unit, University Hospital ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
| | - Alessandro Pedicelli
- Institute of Radiology (Interventional Neuroradiology Unit) University Hospital ‘A. Gemelli’, Catholic University of Sacred Hart, Rome, Italy
| | - Andrea Alexandre
- Institute of Radiology (Interventional Neuroradiology Unit) University Hospital ‘A. Gemelli’, Catholic University of Sacred Hart, Rome, Italy
| | - Sandro Pelo
- Maxillo-Facial Unit, University Hospital ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
| | - Piero Doneddu
- Maxillo-Facial Unit, University Hospital ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
| | - Giulio Gasparini
- Maxillo-Facial Unit, University Hospital ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
| | - Umberto Garagiola
- Department of Biomedical, Surgical and Oral Sciences, School of Dentistry, University of Milan, Milan, Italy
| | - Giuseppe D’Amato
- Maxillo-Facial Unit, University Hospital ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
| | - Gianmarco Saponaro
- Maxillo-Facial Unit, University Hospital ‘A. Gemelli’, Catholic University of Sacred Heart, Rome, Italy
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16
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Deib G, El Mekabaty A, Gailloud P, Pearl MS. Treatment of hemorrhagic head and neck lesions by direct puncture and nBCA embolization. BMJ Case Rep 2017; 2017:bcr-2017-013335. [PMID: 29070606 DOI: 10.1136/bcr-2017-013335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Life-threatening bleeding in the head and neck region requires urgent management. These hemorrhagic lesions, for example, a ruptured pseudoaneurysm, are often treated by transarterial embolization (TAE), but prior intervention or surgery, inflammation, anatomic variants, and vessel tortuosity may render an endovascular approach challenging, time-consuming, and sometimes impossible. We report two cases of severe head and neck hemorrhages successfully embolized with n-butyl cyanoacrylate via direct puncture, and propose this approach as a fast, safe, and effective alternative to TAE.
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Affiliation(s)
- Gerard Deib
- Division of Interventional Neuroradiology, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Amgad El Mekabaty
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Philippe Gailloud
- Division of Interventional Neuroradiology, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Monica Smith Pearl
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Department of Radiology, Children's National Medical Center, District of Columbia, USA
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17
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Casal D, Pelliccia G, Pais D, Carrola-Gomes D, Angélica-Almeida M, Videira-Castro J, Goyri-O'Neill J. Stab injury to the preauricular region with laceration of the external carotid artery without involvement of the facial nerve: a case report. J Med Case Rep 2017; 11:205. [PMID: 28754171 PMCID: PMC5534056 DOI: 10.1186/s13256-017-1361-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 06/22/2017] [Indexed: 12/03/2022] Open
Abstract
Background Open injuries to the face involving the external carotid artery are uncommon. These injuries are normally associated with laceration of the facial nerve because this nerve is more superficial than the external carotid artery. Hence, external carotid artery lesions are usually associated with facial nerve dysfunction. We present an unusual case report in which the patient had an injury to this artery with no facial nerve compromise. Case presentation A 25-year-old Portuguese man sustained a stab wound injury to his right preauricular region with a broken glass. Immediate profuse bleeding ensued. Provisory tamponade of the wound was achieved at the place of aggression by two off-duty doctors. He was initially transferred to a district hospital, where a large arterial bleeding was observed and a temporary compressive dressing was applied. Subsequently, the patient was transferred to a tertiary hospital. At admission in the emergency room, he presented a pulsating lesion in the right preauricular region and slight weakness in the territory of the inferior buccal branch of the facial nerve. The physical examination suggested an arterial lesion superficial to the facial nerve. However, in the operating theater, a section of the posterior and lateral flanks of the external carotid artery inside the parotid gland was identified. No lesion of the facial nerve was observed, and the external carotid artery was repaired. To better understand the anatomical rationale of this uncommon clinical case, we dissected the preauricular region of six cadavers previously injected with colored latex solutions in the vascular system. A small triangular space between the two main branches of division of the facial nerve in which the external carotid artery was not covered by the facial nerve was observed bilaterally in all cases. Conclusions This clinical case illustrates that, in a preauricular wound, the external carotid artery can be injured without facial nerve damage. However, no similar description was found in the reviewed literature, which suggests that this must be a very rare occurrence. According to the dissection study performed, this is due to the existence of a triangular space between the cervicofacial and temporofacial nerve trunks in which the external carotid artery is not covered by the facial nerve or its branches.
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Affiliation(s)
- Diogo Casal
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal. .,Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal.
| | - Giovanni Pelliccia
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Diogo Pais
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Diogo Carrola-Gomes
- General Surgery Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Maria Angélica-Almeida
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - José Videira-Castro
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - João Goyri-O'Neill
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
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18
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Baptista-Sincos APW, Simplício AB, Sincos IR, Leaderman A, Neto FS, Moraes A, Aun R. Flow-diverting Stent in the Treatment of Cervical Carotid Dissection and Pseudoaneurysm: Review of Literature and Case Report. Ann Vasc Surg 2017; 46:372-379. [PMID: 28689955 DOI: 10.1016/j.avsg.2017.06.151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 06/04/2017] [Accepted: 06/29/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The endovascular technique has been recommended over the past few years to extracranial carotid dissection and pseudoaneurysm with promising results, especially after medical therapy failure. Flow-diverting stents are an alternative for complex cases. These stents have proven to be effective treatment devices for intracranial aneurysms. METHODS The reference list of Pham's systematic review, published in 2011, and Seward's literature review, published in 2015, was considered, as well as all new articles with eligible features. Search was conducted on specific databases: MEDLINE and Literatura Latino-Americana e do Caribe em Ciências da Saúde. RESULTS For carotid dissection and pseudoaneurysm, our review yielded 3 published articles including 12 patients. The technical success rate of flow-diverting stent was 100% with no procedural complication described. Mean clinical follow-up was 27.2 months (range 5-48), and in 5 months' angiographic follow-up, all lesions had healed. No new neurological events were reported during the clinical follow-up. CONCLUSIONS Flow diverter stent use on intracranial and peripheral vascular surgery demonstrates satisfactory initial results, but it is still under investigation. There are very few cases treated till now and the initial results with flow-diverting stents to cervical carotid dissection are promising. In well-selected cases, where simple embolization or conventional stent is not appropriate, this technic may be considered.
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Affiliation(s)
| | - Aline Bigatão Simplício
- Department of Surgery, Vascular and Endovascular Division of Albert Einstein Hospital, São Paulo, SP, Brazil
| | - Igor Rafael Sincos
- Department of Surgery, Vascular and Endovascular Division of Albert Einstein Hospital, São Paulo, SP, Brazil
| | - Alex Leaderman
- Department of Surgery, Vascular and Endovascular Division of Albert Einstein Hospital, São Paulo, SP, Brazil
| | - Fernando Saliture Neto
- Department of Surgery, Vascular and Endovascular Division of Albert Einstein Hospital, São Paulo, SP, Brazil
| | - Adjaldes Moraes
- Department of Surgery, Vascular and Endovascular Division of Albert Einstein Hospital, São Paulo, SP, Brazil
| | - Ricardo Aun
- Department of Surgery, Vascular and Endovascular Division of Albert Einstein Hospital, São Paulo, SP, Brazil
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19
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Amuluru K, Al-Mufti F, Roth W, Prestigiacomo CJ, Gandhi CD. Anchoring Pipeline Flow Diverter Construct in the Treatment of Traumatic Distal Cervical Carotid Artery Injury. INTERVENTIONAL NEUROLOGY 2017; 6:153-162. [PMID: 29118792 DOI: 10.1159/000457836] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Traumatic extracranial internal carotid artery (ICA) dissections are uncommon and can be difficult to treat. Thinning of adventitia and dilatation may occur following arterial dissection, thus resulting in a fusiform pseudoaneurysm, which can subsequently cause bleeding, expanding, or pulsatile hematoma. Currently, medical management with anticoagulation remains the first line of treatment and yields good outcomes in 75% of cases with a mortality rate of 3-4%. Endovascular intervention is indicated with failure of medical therapy, progressive enlargement of a traumatic pseudoaneurysm, acute flow-related infarcts due to vessel occlusion, or when anticoagulation is contraindicated due to risk of pseudoaneurysm rupture and hemorrhage. Recognized interventional treatments include parent artery occlusion with or without revascularization, endovascular coil embolization, and covered stenting. Summary A wide variety of endovascular stents are available that are capable of opening a stenosed vessel while obliterating the associated false lumen and providing a scaffold for embolization of the pseudoaneurysm. The use of the Pipeline Embolization Device (PED) in the management of traumatic intracranial pseudoaneurysms has been described. However, there are few reports on the usage of the PED for treating traumatic extracranial ICA dissection and/or pseudoaneurysms. However, a potential complication of the use of PED in the extracranial ICA is a hypothetical tendency to migrate in a mobile vessel. Thus, the risk of migration of the PED has encouraged practitioners to adopt strategies to limit this risk. Key Messages We describe different techniques employed to anchor the flow-diverting construct within tortuous, mobile vessels.
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Affiliation(s)
- Krishna Amuluru
- Department of Neurosurgery and Neuroscience, Rutgers University New Jersey Medical School, Newark, New Jersey, USA.,Department of Department of Interventional Neuroradiology, University of Pittsburgh Medical Center Hamot, Erie, Pennsylvania, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery and Neuroscience, Rutgers University New Jersey Medical School, Newark, New Jersey, USA
| | - William Roth
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Charles J Prestigiacomo
- Department of Neurosurgery and Neuroscience, Rutgers University New Jersey Medical School, Newark, New Jersey, USA.,Department of Neurology, Rutgers University New Jersey Medical School, Newark, New Jersey, USA.,Department of Radiology, Rutgers University New Jersey Medical School, Newark, New Jersey, USA
| | - Chirag D Gandhi
- Department of Neurosurgery and Neuroscience, Rutgers University New Jersey Medical School, Newark, New Jersey, USA.,Department of Neurology, Rutgers University New Jersey Medical School, Newark, New Jersey, USA.,Department of Radiology, Rutgers University New Jersey Medical School, Newark, New Jersey, USA
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20
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Han HJ, Jung JH, Hong CK, Kim YB. The Neck and Posterior Fossa Combined Penetrating Injury: A Case Report. Korean J Neurotrauma 2016; 12:175-179. [PMID: 27857932 PMCID: PMC5110913 DOI: 10.13004/kjnt.2016.12.2.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/09/2016] [Accepted: 08/24/2016] [Indexed: 11/23/2022] Open
Abstract
Here we report a case of penetrating neck injury to the posterior fossa that was shown, using high-resolution computed tomography (HRCT) and digital subtraction angiography (DSA), to involve no vascular injury. A 54-year-old man was brought to the emergency department after a penetrating injury to the left side of the posterior neck and occipital area with a knife. He was in an intoxicated state and could not communicate readily. On initial examination, his vital signs were stable and there was no active bleeding from the penetrating site. Because of concern about possible injury to adjacent vessels, we performed HRCT and DSA sequentially, and identified that the blade of the knife had just missed the arteriovenous structures in the neck and posterior fossa. The patient was then transferred to the operating room where the knife was gently removed. Further careful exploration was performed through the penetrating wound, and we confirmed that there were no major injuries to the vessels and neural structures. Postoperative computed tomography revealed that there was minimal hemorrhage in the left cerebellar hemisphere. The patient made a full recovery without any neurologic deficit. In this case, HRCT is a suitable tool for the initial overall evaluation. For the evaluation of vascular injury, DSA can be a specific and accurate tool. Mandatory exploration widely used for penetrating injuries. After careful preoperative evaluation and interpretation, simple withdrawal of material can be a choice of treatment.
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Affiliation(s)
- Hyun Jin Han
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Ho Jung
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Ki Hong
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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21
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Penetrating Cervical Trauma. "Current Concepts in Penetrating Trauma", IATSIC Symposium, International Surgical Society, Helsinki, Finland, August 25-29, 2013. World J Surg 2015; 39:1363-72. [PMID: 25561188 DOI: 10.1007/s00268-014-2919-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Patients with penetrating wounds to the neck present with overt symptoms and/or signs or are asymptomatic or modestly/moderately symptomatic. With overt symptoms and/or signs, immediate resuscitation and an emergency operation are appropriate. Asymptomatic patients or those with modest or moderate symptoms and/or signs undergo observation or a diagnostic evaluation to avoid the 45% "negative" exploration rate documented in the past (denominator = all patients). Asymptomatic patients with penetration of the platysma muscle, but no signs of a visceral or vascular injury, should undergo serial physical examinations every 6-8 for 24-36 h before discharge. Noncontrast CT does not add to the accuracy of serial physical examinations. In stable patients with a variety of modest/moderate symptoms or signs possibly related to an injury to the carotid artery, CT-arteriography has become the diagnostic modality of choice. Patients with possible injuries to the cervical esophagus are often still evaluated with a Gastrografin swallow and, if needed, a "thin" barium swallow prior to fiberoptic esophagoscopy. CT-esophagograms are likely to replace these time-honored studies in the near future. Over 85% of patients with injuries to the trachea present with overt symptoms or signs, while the remainder have historically been evaluated with laryngoscopy and fiberoptic bronchoscopy. Again, cervical multislice CT is likely to replace these studies. Operative repair of the carotid artery with 6-0 polypropylene sutures requires heparinization and shunting on rare occasions. Both the trachea and esophagus are repaired with 3-0 absorbable sutures, and tracheostomy and esophageal diversion are used in only large and/or complex injuries. Sternal head or sternocleiodomastoid interposition flaps are used when combined visceral and vascular injuries are present.
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22
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Rérolle C, Pucheux J, Lefrancq T, Barrault C, Saint-Martin P. Contribution of Antemortem Computed Tomography Findings to Cause of Death Determination: An Unusual Fatal Stroke. J Forensic Sci 2015; 60:1095-8. [PMID: 25782621 DOI: 10.1111/1556-4029.12760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/03/2014] [Accepted: 07/13/2014] [Indexed: 12/01/2022]
Abstract
In the case reported here, the antemortem computed tomography scan (CT scan) was essential in the forensic investigation. A 32-year-old man was found fully awake with a facial abrasion, after what seemed to be a car accident. He lost consciousness suddenly one hour after initial management. Successive CT scan showed a facial fracture and a metallic foreign body in the carotid canal associated with an occlusion/dissection of the left internal carotid, a pseudoaneurysm, and a carotid-cavernous fistula. The victim died from a stroke. Autopsy confirmed that the facial abrasion was a gunshot entrance wound, the metallic foreign body being a projectile. Intracranial vascular injuries linked with gunshot wounds are most of the time isolated and due to pelet embolism. The observed vascular injury association has never been described in the existing literature. The CT scan provided a better understanding of the chronology of events that led to death.
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Affiliation(s)
- Camille Rérolle
- Institut Médico-Légal, Université François Rabelais, Centre Hospitalier Régionnal Universitaire, Tours, France
| | - Julien Pucheux
- Pôle d'Imagerie M'dicale, Université François Rabelais, Centre Hospitalier Régional Universitaire, Tours, France
| | - Thierry Lefrancq
- Centre de Pathologie, Le Vauban, 16 rue Clerget, BP 549, Nevers, 58009, France
| | - Céline Barrault
- Institut Médico-Légal, Université François Rabelais, Centre Hospitalier Régionnal Universitaire, Tours, France
| | - Pauline Saint-Martin
- Institut Médico-Légal, Université François Rabelais, Centre Hospitalier Régionnal Universitaire, Tours, France
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23
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Prasad R, Sieren LM, Schwartz MZ. Successful endovascular repair of exsanguinating penetrating carotid artery injury in two pediatric patients. Pediatr Surg Int 2015; 31:311-5. [PMID: 25603763 DOI: 10.1007/s00383-015-3658-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 10/24/2022]
Abstract
Immediate operative exploration has been considered mandatory for all penetrating injuries to Zone II of the neck and in any patient who is unstable, regardless of the location of the injury. We report two cases of penetrating carotid artery injuries in children successfully managed with endovascularly placed covered stents. These cases demonstrate that endovascular carotid artery repair can be considered in children, including in patients with Zone II injuries and in initially unstable patients.
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Affiliation(s)
- Rajeev Prasad
- Department of Pediatric General, Thoracic, and Minimally Invasive Surgery, Drexel University College of Medicine, St. Christopher's Hospital for Children, 160 East Erie Avenue, Philadelphia, PA, 19134, USA
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24
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Wang D, Su L, Han Y, Fan X. Embolization treatment of pseudoaneurysms originating from the external carotid artery. J Vasc Surg 2014; 61:920-6. [PMID: 25498162 DOI: 10.1016/j.jvs.2014.10.093] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/20/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to review a single-institution contemporary experience with embolization treatment of pseudoaneurysms (PAs) from the external carotid artery (ECA). METHODS From December 2000 to June 2014, PAs in the head and neck of 17 patients underwent embolization treatment and were retrospectively evaluated. All were treated with obliteration of the feeding artery or the PA by detachable coils or fibered coils, or both. Clinical follow-up was a mean of 91.9 months (range, 4-173 months) and was performed for all patients. Therapeutic outcomes were determined by evaluating the postprocedural image and clinical outcome of symptoms and signs. RESULTS The 17 consecutive patients with head and neck PAs who underwent coils embolization treatment consisted of 14 male patients (82.3%) and three female patients (17.7%). The average age was 37.5 years (range, 16-57 years). The most common symptom and sign was a pulsatile mass, seen in 15 of 17 patients, and other symptoms included pain (three patients) or bleeding (four patients). Digital substraction angiography revealed that the PAs originated from the ECA in 3 patients and others originated from the branches of the ECA, including the superficial temporal artery in 6 patients, internal maxillary artery in 4, superior thyroid artery in 2, and the facial artery and posterior auricular artery in 1. Seventeen coils embolizations for occlusion of the parent artery were performed in 14 patients with a transarterial approach and in three by direct percutaneous puncture. All patients remained symptom free, and no procedure-related complications occurred. CONCLUSIONS Embolization treatment of PAs from the ECA is a useful alternative to standard surgical repair. This modality avoids the necessity for surgical exposure of the face and of the neck with its inherent morbidity.
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Affiliation(s)
- Deming Wang
- Department of Radiology, the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Lixin Su
- Department of Oral and Maxillofacial Surgery & Head and Neck Oncology, the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Yifeng Han
- Department of Radiology, the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Xindong Fan
- Department of Radiology, the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
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25
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Pomara C, Bello S, Serinelli S, Fineschi V. A rare and lethal case of right common carotid pseudoaneurysm following whiplash trauma. Forensic Sci Med Pathol 2014; 11:69-73. [PMID: 25420882 DOI: 10.1007/s12024-014-9629-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2014] [Indexed: 12/01/2022]
Abstract
Whiplash trauma from a car crash is one of the most common causes of neck injury, resulting in pain and dysfunction. We report on an unusual case of post-whiplash pseudoaneurysm of the right common carotid artery, which led to acute massive hemorrhage and death days after the initial trauma. A post-mortem computed tomography angiography showed rupture of the pseudoaneurysm of the right common carotid artery with the contrast agent leaking out into the mouth. The subsequent autopsy confirmed a large hemorrhagic clot extending to the right side of the neck and mediastinum. A rupture of the right wall of the oropharynx was identified with massive bronchial hemoaspiration. The case demonstrates a rare but lethal clinical entity, and is important in providing a better understanding of the potentially fatal consequences of minor trauma, such as whiplash injury, and its physiopathological mechanisms. Thus, changing symptoms after a whiplash injury should be carefully evaluated since they can be related to the underlying severe consequences of a rapid hyperextension-hyperflexion of the neck, as in the reported case.
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Affiliation(s)
- Cristoforo Pomara
- Department of Forensic Pathology, University of Foggia, Viale degli Aviatori 1, 71100, Foggia, Italy
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26
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Pan YH, Lin Y, Ding SH, Chen L, Liang YM, Yin YH, Bao YH, Gao GY, Qiu YM, Jiang JY. Endovascular treatment of the extracranial carotid pseudoaneurysms resulting from stab penetrating injury using overlapping bare stents. Vasc Endovascular Surg 2014; 48:337-41. [PMID: 24476789 DOI: 10.1177/1538574413518613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Injury pertaining to the common carotid artery may result in complete or partial arterial transection, pseudoaneurysms, or arteriovenous connections. Endovascular treatment option of the pseudoaneurysm has already been established with favorable success rate and minimal morbidity. Our purpose is to report one 18-year-old male patient having 2 traumatic pseudoaneurysms as a result of penetrating stab injury in the extracranial common carotid. The patient was successfully treated using 2 overlapping bare-metal stents. The 2 common carotid pseudoaneurysms had different degree inflow angles defined as the space between the lines indicating the direction of blood flow from the parent artery and through the aneurysmal neck to the dome. Computed tomography angiography was utilized to follow the evolution of the pseudoaneurysms until total occlusion was demonstrated. The treatment modality used in this report represents an alternative approach of the endovascular treatment for the extracranial carotid pseudoaneurysm.
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Affiliation(s)
- Yao-hua Pan
- Department of Neurological Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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27
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Vijayvergiya R, Kumar A, Shrivastava S, Kamana NK, Singhal M. Images in vascular medicine. Endovascular repair of a post-traumatic right common carotid artery pseudoaneurysm. Vasc Med 2013; 18:374-5. [PMID: 23939016 DOI: 10.1177/1358863x13498133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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28
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Pulli R, Dorigo W, Pratesi G, Fargion A, Pratesi C. Single-Center Experience on Endovascular Repair of Noninfected Extracranial Internal Carotid Artery Pseudoaneurysms. Ann Vasc Surg 2013; 27:672.e13-7. [DOI: 10.1016/j.avsg.2012.07.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 07/10/2012] [Accepted: 07/13/2012] [Indexed: 10/26/2022]
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29
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Traumatismo de arteria carótida interna. ANGIOLOGIA 2013. [DOI: 10.1016/s0003-3170(13)70071-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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30
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Almazedi B, Lyall H, Bhatnagar P, Kessel D, McPherson S, Patel JV, Puppala S. Endovascular Management of Extra-cranial Supra-aortic Vascular Injuries. Cardiovasc Intervent Radiol 2013; 37:55-68. [DOI: 10.1007/s00270-013-0555-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
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31
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Jindal G, Gemmete J, Gandhi D. Interventional Neuroradiology Applications in Otolaryngology, Head and Neck Surgery. Otolaryngol Clin North Am 2012; 45:1423-49. [DOI: 10.1016/j.otc.2012.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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