Management of Great Vessel Injury
The great vessels and their major branches traverse the superior mediastinum, thoracic outlet and the neck. Understandably, injuries to these vessels constitute one of the most challenging acute problems confronting the surgeon. Vascular injuries in this area constitute approximately 12% of all vascular trauma and the majority are penetrating injuries. Hemorrhage from brachiocephalic arteries and branches is frequently associated with injuries to adjacent vital structures, and this accounts not only for the high mortality at the scene or in transit, but also for severe hypotension of patients on arrival in the emergency room. When survival occurs, priorities are for immediate resuscitation, recognition of the true extent and complexity of the injury, and prompt operative intervention for access, control and repair of vessels. Blunt trauma is less common, but can be particularly difficult to manage when it involves the airway. The sudden deceleration forces involved in road traffic accidents may result in hyperextension injuries of the carotid and vertebral arteries which may occur in the absence of bony injury. Diagnosis of these injuries can be difficult as initially they are often unaccompanied by neurological deficits and the consequences of missing such injuries may be devastating. Neurological deficits, when present, may include cranial nerve palsies and Horner’s syndrome in addition to hemispheric ischemia.
KeywordsVertebral Artery Subclavian Artery Blunt Trauma Median Sternotomy Artery Injury
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