Iatrogenic Carotid Artery Injury Research Articles

Percutaneous Suture - Closure Device Used for Iatrogenic Carotid Artery Injury Management: Case Report and Review of Literature.

Accidental carotid artery injury is an uncommon but serious central venous catheter insertion complication. Hemostasis might not be readily achieved by manual compression; therefore, surgery or endovascular treatment remains the mainstay for accidental carotid artery injury. However, not all patients are suitable candidates for surgery.Vascular closure devices are widely used in femoral arteries to achieve hemostasis and early ambulation. The use of vascular closure devices is occasionally reported in other vascular beds. Here we present a case of an iatrogenic left common carotid artery injury treated by vascular closure device, which is of help in the future management of this complication.

Intraoperative Carotid Artery Injuries. Review of the literature, analysis of the material of one centre.

<b>Introduction:</b> Injuries of the carotid artery constitute a rare group of injuries. This study presents results of the treatment of 44 patients with iatrogenic carotid artery injuries for over 20 years. The patients were treated by the team of doctors of the Department of Vascular, General and Transplant Surgery in Wroclaw in the years 1997-2017 (Head of the Department Prof. Klemens Skóra, MD, and Prof. Piotr Szyber, MD, PhD - material used with permission). </br></br> <b>Aim:</b> Aims of the analysis are: to estimate the frequency of different forms of iatrogenic injuries to the common and internal carotid artery, to evaluate the results of treatment, to assess the most effective surgical method depending on the type of injury, and develop an effective preoperative, intraoperative and postoperative regimen.</br></br> <b>Discussion and results:</b> The frequency of various carotid artery injuries (blunt, acute, traffic) was constant between years, but the number of iatrogenic injuries definitely increased over time. The prognosis for patients with carotid artery injury, especially when combined with multi-organ trauma, is the gravest. Significantly better treatment results were achieved with both acute and iatrogenic injuries. This is mainly due to easier and quicker diagnosis and better conditions for assisting patients.</br></br> <b>Conclusions:</b> In iatrogenic injuries, a well-designed surgical scheme, i.e. primarily the administration of UTH and placing a temporary flow drain by the first operating team, reduces the risk of neurological complications.

Intraoperative Carotid Artery Injuries. Review of the literature, analysis of the material of one centre

<br><b>Introduction:</b> Injuries of the carotid artery constitute a rare group of injuries. This study presents results of the treatment of 44 patients with iatrogenic carotid artery injuries for over 20 years. The patients were treated by the team of doctors of the Department of Vascular, General and Transplant Surgery in Wroclaw in the years 1997–2017 (Head of the Department Prof. Klemens Skóra, MD, and Prof. Piotr Szyber, MD, PhD – material used with permission).</br> <br><b>Aim:</b> Aims of the analysis are: to estimate the frequency of different forms of iatrogenic injuries to the common and internal carotid artery, to evaluate the results of treatment, to assess the most effective surgical method depending on the type of injury, and develop an effective preoperative, intraoperative and postoperative regimen.</br> <br><b>Discussion and results:</b> The frequency of various carotid artery injuries (blunt, acute, traffic) was constant between years, but the number of iatrogenic injuries definitely increased over time. The prognosis for patients with carotid artery injury, especially when combined with multi-organ trauma, is the gravest. Significantly better treatment results were achieved with both acute and iatrogenic injuries. This is mainly due to easier and quicker diagnosis and better conditions for assisting patients.</br> <br><b>Conclusions:</b> In iatrogenic injuries, a well-designed surgical scheme, i.e. primarily the administration of UTH and placing a temporary suction drain by the first operating team, reduces the risk of neurological complications.</br>

Missed Carotid Artery Cannulation: A Line Crossed and Lessons Learnt

We report a case of an infusion of intra-aortic propofol after the missed inadvertent placement of a central venous catheter into the right common carotid artery. Radiological imaging revealed bilateral ischaemic infarcts in the posterior fossa and right cerebral artery territories consistent with an embolic source. The potential causes of the neurological injuries sustained in this case are explored. Discussion focuses on the sequelae, management and prevention of an iatrogenic carotid artery injury from a central venous catheter insertion. Finally, we propose an algorithm for management of iatrogenic carotid artery cannulation.

Iatrogenic carotid artery injury in neurosurgery

Iatrogenic carotid artery injury (CAI) results from various neurosurgical procedures. A review of the literature was conducted to provide an update on the management of this potentially devastating complication. Iatrogenic CAIs are categorized according to each diagnostic or therapeutic procedure responsible for the injury, i.e., anterior cervical spine surgery, central venous catheterization, chemical substances, chiropractic manipulation, diagnostic cerebral angiography, middle-ear surgery, percutaneous procedures for trigeminal neuralgia, radiation therapy, skull-base surgery, tracheostomy, and transsphenoidal surgery. The incidence, mechanisms of injury, diagnostic imaging modalities, and reparative procedures are discussed for each procedure. Iatrogenic CAI may be more prevalent than had previously been thought, mostly because of a heightened awareness on the part of physicians and the earlier detection of asymptomatic patients owing to sophisticated and less-invasive imaging modalities. Prevention is the best treatment for every iatrogenic injury, and it is expected that further accumulation of experience with and knowledge of iatrogenic CAI will result in further reduction of this complication. Although some CAIs, such as radiation-induced carotid artery stenosis, may not be preventable, earlier intervention before the patient becomes symptomatic may favorably alter the prognosis. Following the rapid development of endovascular techniques in recent years, surgically inaccessible lesions can be treated in a more reliable and safe manner than before.

Iatrogenic carotid artery injury in neurosurgery

The quantitative analysis of unfavorable outcome and complication is indispensable for effective risk management. Common complications such as perforator infarction after clipping of the cerebral aneurysm, for example, have been well investigated. However, I regret to say, rare complications are not necessarily investigated so far. In particular, “iatrogenic” complications such as carotid artery injury have been rarely reviewed since it implies some medical liability problem, and such iatrogenic complications are not always reported in official journals. In this sense, this is an extensive review of an important complication that may be underestimated so far. Readers can get in touch with the knowledge of these rare but serious iatrogenic complications. I am confident that this knowledge will help neurosurgeons to avoid these serious complications. The remarkable point of this review is that it has thoroughly reviewed all aspects of iatrogenic carotid artery injuries, including very common procedures such as central venous catheterization. In addition, the authors ranged extensively into the literature over these rare complications and showed us quantitative data. I am quite sure that this paper may give truly educative and practical information to all readers of this journal. I am confident that this paper will be cited hereafter due to its quantitative data and its extensive review of the literature.