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Vascular Injuries Secondary To Penetrating Neck Trauma
Anish M. Patel, BA, Kyle Bui, BS, Andrea Alonso, MD, Sophia Smith, MD, Elizabeth King, MD, Alik Farber, MD, MBA, Sabrina Sanchez, MD, MPH, Crisanto Torres, MD, MPH, Noelle Saillant, MD, Jeffrey J. Siracuse, MD, MBA.
Boston University, Boston, MA, USA.
OBJECTIVES: Penetrating neck trauma with vascular injury can have significant morbidity. Our goal was to examine the management and outcomes of vascular injuries secondary to penetrating neck trauma.
METHODS: A single-center retrospective study identified patients with penetrating neck trauma with vascular injury (2014-2024). Injury characteristics, management, and subsequent morbidity were analyzed.
RESULTS: There were 47 patients with penetrating neck trauma and associated vascular injury. Average age was 37.5 years, 80.9% were male, and 57% were of Black race. Mechanisms were stabbing (57.4%), firearm (34%), and other causes including dog bites (8.5%). Vascular injuries were arterial (23.4%), venous (51.1%), and combined arterial/venous. Concurrent aerodigestive injuries occurred in 23.4% of cases. Median time from injury to emergency department (ED) presentation was 20 minutes, with 48.9% intubated enroute or on arrival. There were 72.3% that had an emergency intervention with median time to operating room of 35-minutes. Open arterial repairs included 10% carotid artery bypass, 35% carotid artery repair, and 55% arterial ligation of neck arteries. Open venous repair included 93.1% ligation and 13.8% primary vein repair. Endovascular interventions were vertebral (67%) and inferior thyroid artery (33%) embolizations.
There were 12.8% of patients who died soon after presentation (67% trauma bay and 33% in the operating room), and 12.8% suffered a stroke. There were no 30-day or 1-year deaths after discharge, but 25% of patients had at least one 30-day ED visit. Follow up imaging was received by 66% of discharged patients with an arterial repair.
CONCLUSIONS: Penetrating neck trauma with vascular injuries require prompt operative repair and are associated with high initial mortality and stroke rate. Combined arterial and venous injuries are common, and aerodigestive injuries should be considered during initial presentation. High rates of ED utilization post-discharge suggest the need for improved follow-up in this patient population.
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