[...]... Extracranial carotid injuries are also reported to be 7 8 Chapter 1 Vascular Injuries to the Neck NOTE A patient with neck trauma and a possible vascular injury who is stable, has stabilized after resuscitation, or has a transcervical gunshot injury should undergo a selective aortic arch angiography 1. 5 Management and Treatment 1. 5 .1 Management Before Treatment 1. 5 .1. 1 Management in the Emergency Department... require an experienced vascular surgeon, a thoracic surgeon, an endovascular specialist, and frequently also a specialist in head and neck surgery, some patients would benefit from being transported to a hospital 9 10 Chapter 1 where such expertise is available A stable patient can be transported to another hospital after intubation, or with readiness for emergency intubation in the ambulance, with no major... Stroke Death Stroke Death 3% 11 % 19 % 31% I Luminal irregularity or dissection, 25% narrowing or intraluminal thrombus or raised intimal flap 11 % 11 % 40% 0 III Pseudoaneurysm 33% 11 % 13 % 13 % IV Occlusion 44% 22% 33% 11 % V Transection and free extravasation 10 0% 10 0% – – 1. 5.4 Results and Outcome Several authors report better results after repair of... veins by a traumatic technique (See Chapter 15 on vascular surgical technique.) Vascular Injuries to the Neck 1. 5.2.6 Endovascular Treatment As already described in sections 1. 5.2.2 and 1. 5.2.4, endovascular technique is an alternative to consider in some cervical vascular injuries Endovascular treatment is the first option in injuries to the vertebral artery due to its location and surgical inaccessibility... surgically managed penetrating carotid artery injuries Eur J Vasc Endovasc Surg 2002; 24:349–355 Reid J, Weigfelt J Forty-three cases of vertebral artery trauma J Trauma 19 88; 28 :10 07 10 12 14 Chapter 1 Romily RC, Newell DW, Grady MS, et al Gunshot wounds of the internal carotid artery at the skull base: management with vein bypass grafts and a review of the literature J Vasc Surg 20 01; 33 :10 01 10 07... The application of detachable balloons, coils, stents, or hemostatic agents is usually successful for managing bleeding, aneurysms, and fistulas Endovascular techniques have also been reported to be successful for managing some carotid artery injuries (such as traumatic lacerations), pseudoaneurysms, and injuries in some noncritical and small terminal branches If endovascular occlusion of an internal... vertebral artery in the cervical region are usually best treated by modern endovascular techniques The options are intraluminal covered stents or endovascular embolization with coil Besides bleeding and hematomas, pseudoaneurysms and arteriovenous fistulas can occur after vertebral artery trauma and also be successfully treated by transcatheter embolization In unstable patients with life-threatening... hypoglossal and vagus nerves The former usually crosses over the internal carotid artery 2–3 cm cranial to the bifurcation and is best exposed after cranial retraction of the digastric muscle The latter runs parallel and dorsal to the common carotid artery The cervical ansa, often located obliquely over the carotid bifurcation, can be divided to facilitate exposure 1. 5 Management and Treatment Fig 1. 3 a. .. can reveal dissections, thrombotic occlusion, intimal flaps, pseudoaneurysms, and hema- NOTE Injuries not penetrating the platysma need no further vascular evaluation 1. 4.2 Blunt Trauma The diagnosis of vascular injuries after blunt trauma is much more challenging As previously noted, clinical signs and symptoms are frequently subtle or absent, and initial transient or late neurological deficits are... or angiography excludes a major vascular injury, there is no vascular indication for exploration Patients with a history of significant bleeding as well as those with large hematomas should be treated according to what has been described above for proximal control, before exploring the wound and evacuating the hematoma 1. 5.2.4 Injuries to the Vertebral Artery Due to its relatively inaccessible location, . 10 1 Chapter 10 Acute Leg Ischemia 11 9 Part B General Concepts Chapter 11 Vascular Access in Trauma 13 5 Chapter 12 Complications in Vascular Surgery 14 1 Chapter 13 Acute Venous Problems 15 9 Chapter. class="bi x0 y0 w1 h1" alt="" Emergency Vascular Surgery A Practical Guide Eric Wahlberg Pär Olofsson Jerry Goldstone Emergency Vascular Surgery A Practical Guide With 68 Figures and 39 Tables  Eric. after resuscitation, or has a trans- cervical gunshot injury should undergo a selective aortic arch angiography. 1. 5 Management and Treatment 1. 5 .1 Management Before Treatment 1. 5 .1. 1 Management