BEST CASE OF MY CAREER- PART TWO

[sjasmd at aol.com]

I decided that an attempt at stent graft of the external carotid artery had merit in order to maintain the ophthalmic artery collateral and because this would have treated the occipital, posterior auricular and external carotid injuries simultaneously even if it occluded. I thought that the graft had low likelihood of success because of the preexisting post traumatic vasospasm and the small size of the vessel, but i didnt think it would hurt to try.. 

A 5mm? diameter 22mm Atrium stent graft was placed over the injured segment of the ECA and the orifices of both branches. It occluded within minutes. 

The proximal ICA occlusion was secured with three gianturco coils. I chose NOT to try to go through the clotted ICA to the other side?of?this injury for fear of dislodging and embolizing clot into the brain.? 


There was still bleeding from the wound but when the balloon was deflated, there was torrential bleeding. We intermittently let down the balloon and repeated the angiography of the carotid and remaining external carotid branches without seeing any extravasation.? So we repeated angiography of all remaining three cerebral vessels. The left vertebral angiogram is attached.





-----Original Message-----
From: KMATTOX at aol.com
To: trauma-list at trauma.org
Sent: Sun, 29 Jun 2008 10:25 pm
Subject: Re: BEST CASE OF MY CAREER
I have seen the second set of images.    I would also  consider DEFLATING the 
tamponading balloon for a few seconds in order to obtain  a view.   It may be 
that the internal carotid artery is occluded ONLY  by the occluding balloon.  
 
k
 
 
In a message dated 6/29/2008 9:20:14 P.M. Central Daylight Time,  
jduchesn at tulane.edu writes:

sal-  good save!.........is the patient awake? Any lateralizing signs?
I agree  with Norm. Based on this angio view the injury can be approach thru 
formal  sternocleidomastoid approach........I favor repair before 
ligation........  although looks like the ophthalmic artery collateral is open 
like Dr 
Mattox  well mention 
Good case
j
CharityOne

Juan C Duchesne MD, FACS,  FCCP
Trauma and Critical Care Surgery Section
Surgical Hospital Center  Director
Director Surgical Intensive Care Unit  
Louisiana ATLS /  PHTLS State Faculty
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