The Journal of Thoracic and Cardiovascular Surgery, Vol 80, 342-349, Copyright © 1980 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Management of acute cervicothoracic vascular injuries
C Mavroudis, AJ Roon, CC Baker and AN Thomas
One hundred eighty-one patients with 218 acute cervicothoracic vascular
injuries underwent operations for diagnosis, resuscitation, and control of
hemorrhage. The patients were divided into three clinical groups depending
on their clinical status. Group I consisted of 105 patients who were
hemodynamically stable and able to undergo diagnostic measures: Group II
consisted of 41 patients who remained unstable and required immediate
operation; Group III consisted of 35 patients who were moribund and
underwent emergency room thoracotomy. The mortality rates were 4% for Group
I, 15% for Group II, and 80% for Group III with an overall mortality rate
of 21%. Angiography was performed in 53% of the stable Group I patients.
This allowed specific identification of lesions such as arteriovenous
fistula in eight patients and aortic disruption in 12 patients. Thirty-five
Group III patients had thoracotomy performed in the emergency room and
seven survived (20%). A vigorous clinical approach is recommended to
minimize morbidity. A different approach is described for each of the three
clinical groups of patients.
