Outcomes for cervicomediastinal vascular trauma managed by a vascular subspecialistled vascular trauma service

  • Jahangirul Islam University of KwaZulu-Natal
  • Grant L Laing University of KwaZulu-Natal
  • John L Bruce University of KwaZulu-Natal
  • Damian L Clarke University of KwaZulu-Natal
  • George V Oosthuizen University of KwaZulu-Natal
  • J V Robbs University of KwaZulu-Natal
Keywords: Cervicomediastinal, vascular, trauma

Abstract

Background: The management of cervicomediastinal vascular trauma is challenging. We report on our experience with the condition in a newly established vascular trauma service unit, and compare the outcomes to those reported in our parent vascular surgery department.

Method: The details of patients with cervicomediastinal vascular injuries from January 2012 to June 2014 were retrieved for analysis from a prospective database.

Results: Ninety-three patients were identified, 84 of whom were male (90%), with an average age of 29 years. Most were penetrating injuries (89%), and 87% of these were due to stab wounds. There were 107 vascular injuries, 88 cervical and 19 mediastinal. Of these, 87 were arterial and 20 venous injuries. The most common arterial injury involved the subclavian artery (24%), followed by the common carotid artery (22%). Management was multimodal, and included conservative (8%), stenting and embolisation (8%), referral to a higher centre (8%), vascular repair (64%) and ligation (12%). Nineteen per cent required median sternotomy or thoracotomy. Eight patients died postoperatively (9%). Seven of them presented in extremis and died within 24 hours, and one died after a week from associated abdominal injuries. Postoperative complications were 9%. There was no incidence of a stroke or limb loss despite ligation of the arteries, including ligation of four internal carotids.

Conclusion: The development of endovascular techniques would allow for noninvasive management of a significant number of patients. Open surgery is still necessary, and associated with significant morbidity. Comparable results were reported in our newly established vascular trauma service unit to those obtained in our parent vascular surgery department in Durban.

Author Biographies

Jahangirul Islam, University of KwaZulu-Natal

MBBS, DA (SA), FCS (SA), Cert Vasc Surg (SA), M Med Sci (Surg)
Department of Vascular Surgery
Grey's Hospital
Nelson R Mandela School of Medicine
University of KwaZulu-Natal

Grant L Laing, University of KwaZulu-Natal

MBChB, FCS (SA), Cert Trauma Surg (SA)
Department of Trauma Surgery
Grey’s Hospital
Nelson R Mandela School of Medicine
University of KwaZulu-Natal

John L Bruce, University of KwaZulu-Natal

MBChB, FCS (SA)
Department of Trauma Surgery
Grey’s Hospital
Nelson R Mandela School of Medicine
University of KwaZulu-Natal

Damian L Clarke, University of KwaZulu-Natal

MBChB, FCS (SA), M Med Sci, MPhil, MBA
Department of Trauma Surgery
Grey’s Hospital
Nelson R Mandela School of Medicine
University of KwaZulu-Natal

George V Oosthuizen, University of KwaZulu-Natal

MBChB, FCS (SA)
Department of Trauma Surgery
Grey’s Hospital
Nelson R Mandela School of Medicine
University of KwaZulu-Natal

J V Robbs, University of KwaZulu-Natal

MBChB, ChM, FCS (SA), FRCSEd, FRCPS (Glas)
Vascular Surgeon, Entabeni Hospital
Nelson R Mandela School of Medicine
University of KwaZulu-Natal

Published
2016-06-29
How to Cite
Islam, J., Laing, G., Bruce, J., Clarke, D., Oosthuizen, G., & Robbs, J. (2016). Outcomes for cervicomediastinal vascular trauma managed by a vascular subspecialistled vascular trauma service. South African Journal of Surgery, 54(2), 15-20. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/1906
Section
Vascular Surgery