Cervicomediastinal arterial injuries. A surgical challenge
J. V. Robbs, L. W. Baker, R. R. Human, I. S. Vawda, H. Duncan and P. Rajaruthnam
The initial clinical observations and methods and results of treatment in
104 patients with subclavian (48), vertebral (four), and carotid (52)
artery injuries are reported. Delayed hemorrhage ten days after
misdiagnosed subclavian artery injuries resulted in false aneurysms causing
compressive brachial plexus palsies. A conservative approach to penetrating
cervicomediastinal wounds was adopted with selective use of arch
aortography when arterial injury was suspected by defined criteria. This
proved safe, accurate, and invaluable for planning operative approach.
Partial median sternotomy without entering the pleura proved optimal for
superior mediastinal access; simple clavicle transection provided adequate
distal subclavian exposure. External carotid and vertebral arteries were
ligated. No shunts were employed for common and internal carotid repair.
None of the 14 patients revascularized in the presence of a neurologic
deficit died and none was made worse by carotid reconstruction.
