Comments regarding ‘Operative Management of Penetrating Carotid Artery Injuries’

Abstract

Dr. Reva and his colleagues from the Military Medical Academy in Saint-Petersburg, Russia are to be congratulated for their thoughtful review of their management of carotid injuries due to military trauma. In this manuscript the authors present their analysis of 46 patients with injuries to theCCAand ICA. Seventeen civilian patients and twenty-nine soldiers were wounded during combat operations between November 1999 and August 2002. All patients had confirmed injuries to the CCA and ICA, while patients with isolated external carotid artery (ECA) injury were excluded from the analysis. Carotid artery ligation was accomplished in nine patients (19%); the remaining 37 patients underwent vascular repair. Methods of repair included end-to-end anastomosis (37%), lateral sutures (22%), and vein grafting (22%). The management of patients with carotid trauma depends upon numerous factors that the trauma surgeonmust critically analyze in a rapid fashion. In this article the authors point out several of these indications. These include the following criteria made us ligate the injured CA patient instability and the presence of a high zone III ICA injury in the skull base. As reproduced in this study the data support aggressive carotid reconstruction for trauma in all but the most hopeless situations. This was demonstrated byRich et al. during the Vietnam Warwhere patient survival was improved through the repair of all carotid vascular injuries compared to ligation during previous conflicts. Similarly, during the Afghanistan and Iraq conflicts repair of carotid arterial injuries led to improved results. Fox et al. reported on thirty-nine patients (30%) underwent immediate neck exploration in Iraq or Afghanistan, of which 65% (25/39) were positive for amajor injury. Twentyone patients underwent 24 vascular repairs for 13 arterial and