ABSTRACT
The management of 85 patients with penetrating injuries involving the external (n = 19), internal (n = 6) and common carotid (n = 46), vertebral (n = 10) and brachiocephalic (n = 4) arteries over a 5-year period in one hospital is reviewed. Sixty-three patients had no peroperative neurological deficit; 22 presented with localizing neurological signs. Where there was no deficit, the external carotid (n = 19) and vertebral (n = 10) arteries were ligated without adverse sequelae. Arterial reconstruction was performed of the internal carotid (n = 2) which resulted in a temporary neurological deficit in 7 patients and death in 3. Among the 22 patients with a preoperative neurological deficit, arterial reconstruction was performed in 18, which involved the common carotid in 17 patients and the internal, carotid in 1 patient. There was complete neurological recovery in 11 patients and 2 patients died. Four comatose patients had cerebral revascularization performed without fatality and with complete recovery in 3 of them. CT head scanning was not routinely employed for logistic reasons but has proved of limited value. No intraluminal arterial shunts were used in this series. It would seem that arterial reconstruction is not harmful and may well be beneficial to the young patient with extracranial cerebral arterial injury associated with a neurological deficit. Shunts are probably unnecessary for routine use.
Subject(s)
Brachiocephalic Trunk/injuries , Carotid Artery Injuries , Nervous System Diseases/etiology , Vertebral Artery/injuries , Wounds, Penetrating/complications , Adolescent , Adult , Brachiocephalic Trunk/surgery , Carotid Arteries/surgery , Coma/etiology , Female , Humans , Ligation , Male , Methods , Middle Aged , Vertebral Artery/surgery , Wounds, Penetrating/surgeryABSTRACT
The initial clinical observations and methods and results of treatment in 104 patients with subclavian (48), vertebral (four), and carotid (52) artery injuries are reported. Delayed hemorrhage ten days after misdiagnosed subclavian artery injuries resulted in false aneurysms causing compressive brachial plexus palsies. A conservative approach to penetrating cervicomediastinal wounds was adopted with selective use of arch aortography when arterial injury was suspected by defined criteria. This proved safe, accurate, and invaluable for planning operative approach. Partial median sternotomy without entering the pleura proved optimal for superior mediastinal access; simple clavicle transection provided adequate distal subclavian exposure. External carotid and vertebral arteries were ligated. No shunts were employed for common and internal carotid repair. None of the 14 patients revascularized in the presence of a neurologic deficit died and none was made worse by carotid reconstruction.
Subject(s)
Carotid Artery Injuries , Subclavian Artery/injuries , Vertebral Artery/injuries , Adolescent , Adult , Carotid Arteries/surgery , Female , Hemorrhage/etiology , Humans , Male , Methods , Middle Aged , Postoperative Complications/etiology , Subclavian Artery/surgery , Vertebral Artery/surgery , Wounds, Gunshot/complications , Wounds, Stab/complicationsABSTRACT
Three experiments are described in which it is shown that when the spleen is transposed to the retroperitoneal tissues, collaterals from between it and the systemic venous circulation. The first experiment was done on normal rats, the second in rats rendered cirrhotic and the third in a dog and a baboon. It is suggested that retroperitoneal transposition of the spleen may be a useful therapeutic measure in portal hypertension in humans.
