Emergency rescue and vascular reconstruction of carotid artery rupture: A report of 6 cases / 第二军医大学学报

ABSTRACT

Objective To summarize our experience in rescuing fatal bleeding induced by carotid artery rupture(CAR) and in ascular reconstruction. Methods Six patients (11 times) with CAR-induced fatal bleeding were treated in our department uring Dec. 2002 to Dec. 2008. The patients included 4 males and 2 females, with an age range of 12-67 years old and a median of 48 years old. The primary illness included vocal cord paralysis (2 cases) after operation of thyroid carcinoma, recurrent thyroid carcinoma (1 case), recurrent hypopharyngeal carcinoma (1 case), head and neck trauma (1 case) and carotid body tumord case). Four patients received radiotherapy (60-80 Gy) before second operation. One patient (2 times) had in-nominate artery blowout, 4 (8 times) had common carotid blowout, and one had internal carotid artery blowout. CAR occurred during or after surgical operations in 4 patients (8 times) and was caused by external injury in 1 case (1 time). Results Restore of CA after complete exposure of rupture was performed for 5 times, anastomosis by artificial blood vessel for 1 time, direct anastomosis for 1 time, reconstruction by great saphenous vein for 2 times, and ligation of total carotid artery for 2 times. Of all patients, 3 cases undergoing vascular reconstruction succeeded by one try, 2 by 2 tries, and 2 cases underwent ligation of artery because of suture falling off for radiotherapy of infection. Muscle flaps including pectoralis major myocutaneous flap (3 cases) and sternocleidomastoid faps (2 cases) were used to protect vascular anastomosis. All cases were successfully rescued, without perioperative death. One patient developed hemiplegial after ligation of carotid artery. All cases had complete follow-up data. One patient died due to bleeding one week after discharge, 1 died due to ecurrent tumor within one year after operation. By now one patient survived for 3 years and 3 for 5 years. Conclusion Once CAP occurs, prompt press by hands and quick anti-shock procedure are the prerequisites of successful rescue. econstruction or repair of carotid artery can prevent complications of the nervous system, and individualized vascular reconstruction trategy should be employed. Ligation of carotid is effective to rescue patients of CAR, but it should only be chosen when reconstruction is impossible.