Hybrid Endovascular and Direct Surgical Approach for Treatment of Penetrating Common Carotid Artery Injury: A Case Report.

NMC case report journal Pub Date : 2024-12-03 eCollection Date: 2024-01-01 DOI:10.2176/jns-nmc.2024-0148
Dai Uzuki, Ryo Hiruta, Takao Kojima, Yu Naruse, Jun Sakuma, Hiroharu Shinjo, Takashi Igarashi, Masazumi Fujii
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Abstract

Although rare, penetrating cervical vascular injury poses significant challenges with a poor patient prognosis, often attributed to severe hemorrhage and accompanying injuries. We encountered a case of hemorrhagic shock resulting from a penetrating injury to the common carotid artery (CCA), which was successfully managed using a combination of endovascular therapy and direct surgical intervention. A 23-year-old man presented with a self-inflicted stab wound on the left side of his neck from a kitchen knife. This injury resulted in hemorrhagic shock and coma. Initial management included fluid resuscitation and transfusion, with continuous manual compression to control profuse bleeding. Contrast-enhanced neck and brain computed tomography (CT) showed a left CCA injury that was challenging to directly address due to its low anatomical location and continuous bleeding. Neurosurgeons initiated endovascular treatment by placing a guiding balloon catheter proximal to the left CCA for occlusion. Despite this, pulsatile bleeding persisted, prompting the distal placement of a balloon catheter to achieve better bleeding control. Cardiovascular surgeons then performed direct surgery, clearly identifying damage to the anterior and posterior walls of the CCA. The repair involved the use of a self-made cylindrical bovine pericardial patch, which resulted in successful revascularization. Following surgery, the patient regained independent mobility and was discharged. This case emphasizes the importance of a prompt and reliable approach involving endovascular intervention for initial bleeding control followed by precise repair through direct surgery, especially in challenging bleeding scenarios.

血管内与直接手术混合入路治疗穿透性颈总动脉损伤1例。
尽管罕见,但穿透性颈部血管损伤对患者预后不利,通常归因于严重出血和伴随的损伤。我们遇到了一例因颈总动脉(CCA)穿透性损伤引起的失血性休克,并成功地通过血管内治疗和直接手术干预相结合进行了治疗。一名23岁男子脖子左侧被菜刀刺伤。这种损伤导致出血性休克和昏迷。最初的治疗包括液体复苏和输血,持续手动按压以控制大量出血。对比增强颈部和脑部计算机断层扫描(CT)显示左侧CCA损伤,由于其低解剖位置和持续出血,难以直接处理。神经外科医生通过在左侧CCA近端放置引导球囊导管进行血管内治疗。尽管如此,搏动性出血持续存在,促使远端放置球囊导管以更好地控制出血。然后,心血管外科医生进行直接手术,清楚地识别出CCA前后壁的损伤。修复包括使用自制的圆柱形牛心包补片,这导致了成功的血运重建。手术后,患者恢复了独立活动能力并出院。本病例强调了及时、可靠的血管内介入治疗的重要性,包括早期出血控制,然后通过直接手术进行精确修复,特别是在具有挑战性的出血情况下。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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