Iatrogenic injuries of the carotid arteries

Abstract

Background: Iatrogenic trauma of the carotid artery (CA) is a dangerous intraoperative complication, especially during oncological and endocrinological procedures. In these cases massive hemorrhage and severe neurological complications may occur. The outcome of reconstructive procedures is often fatal because of the long delay of surgery after the injuries occuring in non-vascular centers. Patients and methods: In this paper 22 cases of iatrogenic CA trauma will be presented, operated in the period of 1980–2003. Different methods of operation were performed according to the extent of trauma and anatomical changes. Results: In spite of emergency help two patients died. In three cases cerebral stroke was observed. Additionally peripheral nervous damages were noted. Conclusions: Iatrogenic CA trauma is one of the most dangerous vascular injuries, connected with hemorrhage and neurological complications. We recommend intravenous administration of 5000 units unfractionated Heparin, anatomical artery preparation, then shunt inserting. Autogenous material should be used if possible. For reconstruction of the initial part of internal carotid artery the transposition of the external carotid artery is useful.