OUTCOME OF PENETRATING NECK VASCULAR INJURIES - A SINGLE CENTRE EXPERIENCES dristhiyak@gmail.com

 

OUTCOME OF PENETRATING NECK VASCULAR INJURIES - A SINGLE CENTRE EXPERIENCES

2

Sri Lanka

Poster Exhibition only

Penetrating neck injury (PNI) occur in about 5-10% of trauma patients with mortality of 3-10%. PNI involving carotid artery is a challenging problem. Although vascular repair is accepted as the standard of care for patients with carotid injuries and no neurologic deficit, debate continues on as to whether or not repair should be attempted when deficits are present.

This retrospective study (Sept 2019–Mar 2023) reviewed outcomes of patients undergoing surgical neck exploration for PNI, analysing demographics, injury mechanism, presentation, injury zone, operative findings, and outcomes.

Eleven patients were included, 10 (90.9%) male, mean age 45.2 years (18–79). Three were lost to follow-up. Causes included road traffic accidents in 7 (63.6%), and stab or iatrogenic injuries in 2 (18.2%) each. Presentations were bleeding in 7 (63.6%), neck pain in 3 (27.3%), and breathing difficulty in 1 (9.1%). Zone II injuries occurred in 7 (63.6%) patients. Arterial injuries comprised side wall lacerations (7, 63.6%), transections (3, 27.3%), and contusion (1, 9.1%). Procedures included lateral arteriorrhaphy (7, 63.6%), interposition graft repair (3, 27.3%)—2 synthetic, 1 autologous—and external-to-internal carotid transposition (1, 9.1%). At mean follow-up of 460 days, 7 (63.6%) fully recovered, 1 (9.1%) had limb weakness, and 3 (27.3%) died.

The mortality in this series is 27.3%. Patients with iatrogenic injuries have higher mortality due to the associated comorbidities. Out of the patients who underwent carotid artery repair, 87.5% did not have any neurological deficit in the post operative period. Therefore, all the carotid injuries should be repaired irrespective of the neurological status.