Humans ; Neck Injuries/surgery* ; Carotid Artery Injuries/surgery* ; Neck ; Bone Screws/adverse effects* ; Carotid Artery, Common/surgery*

Although penetrating neck trauma (PNT) is uncommon, it is associated with the significant morbidity and mortality. The management of PNT has changed significantly over the past 50 years. A radiological assessment now is a vital part of the management with a traditional surgical exploration. A 22 years old male was assaulted by a screwdriver and sustained multiple penetrating neck injuries. A contrast CT scan revealed a focal pseudoaneurysm in the left common carotid artery bulb. There was no active bleeding or any other vascular injuries and the patient remained haemodynamically stable. In view of these findings, he was initially managed conservatively without an open surgical exploration. However, the patient was noted to have an acute drop in his hemoglobin count overnight post injury and the catheter directed angiography showed active bleeding from the pseudoaneurysm. Surgical exploration 40 hours following the initial injury revealed a penetrating injury through both arterial walls of the left carotid bulb which was repaired with a great saphenous vein patch. A percutaneous drain was inserted in the carotid triangle and a course of intravenous antibiotics for five days was commenced. The patient recovered well with no complications and remained asymptomatic at five months followup.
Carotid Artery Injuries ; diagnostic imaging ; surgery ; Carotid Artery, Common ; surgery ; Computed Tomography Angiography ; Humans ; Male ; Neck Injuries ; diagnostic imaging ; surgery ; Wounds, Penetrating ; diagnostic imaging ; surgery ; Young Adult

Neck, being not protected by skeleton, is vulnerable to external trauma and injury which involves blood vessels, trachea, esophagus and other endocrine and nervous system organs. Vascular injuries can not only cause potentially life-threatening hemorrhage but also need profound surgical expertise in management. Development of collateral circulation in neck is well known; however, there is scarcity of literature on the role of collateral formation in neck trauma. Here, we present a unique case of penetrating gunshot injury to neck with right common carotid and right subclavian artery injury with hemorrhagic shock managed with ligation of these vessels as a life-saving procedure. The patient presented with no neurological or motor deficits in immediate postoperative period owing to the collateral circulation between right vertebral artery and right common carotid and right subclavian artery.
Adult ; Carotid Artery Injuries ; diagnostic imaging ; surgery ; Carotid Artery, Common ; diagnostic imaging ; surgery ; Humans ; Ligation ; Male ; Neck Injuries ; diagnostic imaging ; surgery ; Subclavian Artery ; diagnostic imaging ; injuries ; Tomography, X-Ray Computed ; Wounds, Gunshot ; diagnostic imaging ; surgery

Animals ; Carotid Arteries ; surgery ; Carotid Artery Injuries ; etiology ; Disease Models, Animal ; Female ; Mice ; Mice, Inbred C57BL ; Microsurgery ; Random Allocation

OBJECTIVETo explore the cause, urgent management, further treatment, outcome and prevention of internal carotid artery (ICA) injury during transnasal endoscopic surgery.

METHODSFive ICA injury happened during transnasal endoscopic surgery of sphenoidal sinus and (or) sellar region, involving 1 case of traumatic optic neuropathy, 1 case of sphenoidal cyst, 1 case of fungal sphenoid sinusitis, 1 case of sellar adenoid cystic carcinoma and 1 case of pituitary tumor. These five cases were from three different hospitals in 1990 - 2009, and the clinical data were collected and retrospectively reviewed.

RESULTSInjury of ICA was related with improper anatomic localization and operative procedures. The locations of injury were in cavernous segment in 3 cases, lacerum segment in 1 case, and clinic segment in 1 case, respectively. The types of injury included 3 cases of bleeding of laceration, 1 case of carotid cavernous fistula and 1 case of pseudoaneurysm. Salvage sphenoid sinus packing with vaseline strip and subsequent intravascular stent graft implantation (2 cases) and endovascular embolization (2 cases) effectively controlled bleeding. Four cases were successfully treated without craniocerebral or ocular complications, only 1 case died of massive blood loss. Among 4 survival cases, 1 patient abandoned further therapy, the other 3 patients were cured of primary disease by reoperation or subsequent treatment.

CONCLUSIONPreoperatively, reading carefully the imaging data, intraoperatively, identifying anatomical positions accurately, performing proper operation, and stopping bleeding decidedly, postoperatively, seeking interdisciplinary cooperation to repair vascular damages, all these procedures can effectively reduce the surgical risk of ICA injury.

Adolescent ; Aged ; Carotid Artery Injuries ; etiology ; prevention & control ; surgery ; Carotid Artery, Internal ; Endoscopy ; adverse effects ; methods ; Female ; Humans ; Male ; Middle Aged ; Nose ; surgery ; Retrospective Studies

Carotid artery injury is a very rare, but life threatening complication that can occur during a transsphenoidal approach. We experienced one case of carotid artery injury during a transsphenoidal pituitary tumor surgery. The patient was immediately treated by a balloon occlusion and complete packing of the cavernous carotid artery using Guglielmi detachable coils (GDCs) and the rest of the tumor was removed after the carotid occlusion. The patient recovered without showing any neurological deficits.
Adult ; Carotid Artery Injuries/*therapy ; *Carotid Artery, Internal ; Case Report ; Emergencies ; Human ; Intraoperative Complications/*therapy ; Male ; Pituitary Neoplasms/*surgery ; Sphenoid Bone

OBJECTIVETo investigate the effect of bone marrow derived endothelial cells implantation on healing of acute injured intima.

METHODSMononuclear cells derived from bone marrow were differentiated to endothelial cells. The cells were labeled with bromodeoxyuridine. Carotids injuring was induced by a balloon in 40 rabbits, endothelial cell suspension (2 x 10(6)/ml, n = 20) or PBS (2 ml, n = 20) was infused to injured arteries. The intima covered area was tested by Evan's Blue staining. The average intima thickness and media thickness were observed 7 and 14 days post procedure by histological assay. The immunofluorescent staining was performed for testing the BrdU labeled-cells, and these cells were detected under a fluorescent microscope.

RESULTSIntima covered area rate was significant higher (54.1% +/- 8.2% vs. 30.0% +/- 5.5% at day 7, and 81.8% +/- 6.0% vs. 63.6% +/- 8.4% at day 14, all P < 0.05) and the intima thickness and media thickness were significantly reduced in the endothelial cell suspension group.

CONCLUSIONThe bone marrow derived endothelial cell promoted healing post intima injury in this model compared to PBS group (all P < 0.05).

Animals ; Bone Marrow Cells ; cytology ; Bone Marrow Transplantation ; Carotid Arteries ; pathology ; Carotid Artery Injuries ; pathology ; surgery ; Endothelial Cells ; cytology ; pathology ; transplantation ; Female ; Male ; Rabbits ; Transplantation, Autologous

Epistaxis is commonly encountered in otorhinolaryngologic practice. However, severe and recurrent epistaxis is rarely seen, especially that originating from a pseudoaneurysm of the intracavernous internal carotid artery (ICA). We herein present the case of a 32-year-old man who was involved in a motor vehicle accident and subsequently developed recurrent episodes of profuse epistaxis for the next three months, which required blood transfusion and nasal packing to control the bleeding. Computed tomography angiography revealed a large intracavernous ICA pseudoaneurysm measuring 1.7 cm × 1.2 cm × 1.0 cm. The patient underwent emergent four-vessel angiography and coil embolisation and was discharged one week later without any episode of bleeding. He remained asymptomatic after three-month and one‑year intervals. This case report highlights a large intracavernous ICA pseudoaneurysm as a rare cause of epistaxis, which requires a high index of suspicion in the right clinical setting and emergent endovascular treatment to prevent mortality.
Accidents, Traffic ; Adult ; Aneurysm, False ; diagnostic imaging ; etiology ; surgery ; Carotid Artery Injuries ; Carotid Artery, Internal ; diagnostic imaging ; pathology ; surgery ; Coronary Angiography ; methods ; Embolization, Therapeutic ; Epistaxis ; etiology ; Humans ; Male ; Tomography, X-Ray Computed

Injury to the supraaortic artery is a rare event, with poor prognosis and high mortality. Improvement of the outcome may lie on the combination of several aspects, including better pre-hospital care, use of emergency cardiopulmonary bypass (CPB), improved surgical techniques and facilities, and advanced postoperative intensive care. Some researchers emphasized the importance of emergency CPB in the treatment and thought that it was responsible mainly for the improved outcome. However, there exists controversies about it. In this article, we reported that a patient with life-threatening hemorrhage due to traumatic transection of the left common carotid artery, who was admitted to our hospital in July 2003, was treated successfully with operations with help of emergency CPB and systemic hypothermia.
Accidents, Occupational ; Adult ; Anastomosis, Surgical ; Angiography ; methods ; Cardiopulmonary Bypass ; methods ; Carotid Artery Injuries ; diagnostic imaging ; surgery ; Carotid Artery, Common ; Combined Modality Therapy ; Follow-Up Studies ; Humans ; Injury Severity Score ; Male ; Risk Assessment ; Treatment Outcome ; Vascular Surgical Procedures ; methods

OBJECTIVETo retrospectively analyze a single institution's experience with surgery of the carotid artery performed as part of an oncological procedure and emergency hemostasis, with the aim to determine the preoperative methods for evaluation of cerebral circulation, selection of surgical procedures and perioperative complications.

METHODSFrom January 1999 to December 2004, a total of 35 patients underwent carotid artery surgery including repair of carotid artery in 7 cases, ligation or resection of carotid artery in 17 cases, and reconstruction of carotid artery in 11 cases. All the patients were evaluated for blood flow in the circle of Willis with DSA, DSA plus TBO plus SPECT, and TCD and followed up from 4 months to 4 years. The perioperative complications and surgical outcomes were recorded and analyzed.

RESULTSThere were 16 carotid body tumors, 1 malignant carotid body tumor, 17 malignant tumors involving the carotid artery and 1 traumatic arterio-venous fistula. Twenty-seven patients underwent carotid occlusion test, 10 were positive and 17 were negative (tolerable). Of 7 cases with repair of the carotid artery, 1 patient died of uncontrolled bleeding due to rupture of the anastomosis, and the remaining was uneventful. Of 17 cases with ligation or resection of the carotid artery, 4 developed neurologic deficit 2 weeks postoperatively. Three patients with malignant tumors died 1 month, 4 months, and 4 months postoperatively, respectively. One patient with carotid artery body tumor complained of inarticulate speech 4 months after operation; another patient complained of incapability and limited movement of the ipsilateral upper limbs; 5 patients complained of dizziness 4, 6, 12, 24 and 48 months postoperatively. Of 11 patients who underwent carotid reconstruction, no major cerebral complications were noted after operation. One patient died of recurrence, 1 patient with carotid body tumor complained inarticulate speech and incapability of the contralateral limbs, the remaining was uneventful. Color Doppler showed patent vascular graft 1 year postoperatively.

CONCLUSIONSTBO plus SPECT is a reliable method for evaluation of the circle of Willis currently. The short term and long term complications of ligation of carotid artery are high, therefore, resection and revascularization of the carotid artery is advocated for carotid artery tumors when possible.

Adolescent ; Adult ; Aged ; Balloon Occlusion ; Carotid Arteries ; diagnostic imaging ; surgery ; Carotid Artery Injuries ; diagnostic imaging ; surgery ; Carotid Body Tumor ; diagnostic imaging ; surgery ; Child ; Collateral Circulation ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Tomography, Emission-Computed, Single-Photon ; Vascular Surgical Procedures ; adverse effects ; methods ; Young Adult