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Damage control in penetrating carotid artery trauma: changing a 100-year paradigm

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 manageme...

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Detalles Bibliográficos
Autores principales: Serna, José Julián, Ordoñez, Carlos A., Parra, Michael W., Serna, Carlos, Caicedo, Yaset, Rosero, Alberto, Velásquez, Fernando, Salcedo, Alexander, González-Hadad, Adolfo, García, Alberto, Herrera, Mario Alain, Pino, Luis Fernando, Franco, Maria Josefa, Rodríguez-Holguín, Fernando
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Universidad del Valle 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634279/
https://www.ncbi.nlm.nih.gov/pubmed/34908620
http://dx.doi.org/10.25100/cm.v52i2.4807
Descripción
Sumario: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. If the patient presents with massive bleeding, an expanding neck hematoma or refractory hypovolemic shock, urgent surgical intervention is indicated. 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.