Open AccessDamage control in penetrating carotid artery trauma: changing a 100-year paradigm
Author(s) -
José Julián Serna,
Carlos A. Ordóñez,
Michael W. Parra,
Carlos Serna,
Yaset Caicedo,
Alberto Rosero,
Fernando Velásquez,
Alexander Salcedo,
Adolfo González-Hadad,
Alberto García,
Mario Alain Herrera,
Luis Fernando Pino,
María Josefa Franco,
Fernando Rodríguez-Holguín
Publication year - 2021
Publication title -
colombia medica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.455
H-Index - 18
eISSN - 1657-9534
pISSN - 0120-8322
DOI - 10.25100/cm.v52i2.4807
Subject(s) - medicine , surgery , hematoma , damage control surgery , carotid arteries , ligation , resuscitation
Carotid artery trauma carries a high risk of neurological sequelae and death. Surgical management of these injuries has been controversial because it entails deciding between repair or ligation of the vessel, for which there is still no true consensus either way. This article proposes a new management strategy for carotid artery injuries based on the principles of damage control surgery which include endovascular and/or traditional open repair techniques. The decision to operate immediately or to perform further imaging studies will depend on the patient's hemodynamic status. An urgent surgical intervention is indicated if the patient presents with massive bleeding, an expanding neck hematoma or refractory hypovolemic shock. An altered mental status upon arrival is a potentially poor prognosis marker and should be taken into account in the therapeutic decision-making. We describe a step-by-step algorithmic approach to these injuries, including open and endovascular techniques. In addition, conservative non-operative management has also been included as a potentially viable strategy in selected patients, which avoids unnecessary surgery in many cases.