Trauma Vaskular :

Apakah arteri karotis interna dapat diligasi ?

Jayarasti Kusumanegara
Muhammad Nuralim Mallapasi
Rosie
Mulawardi

Divisi Bedah Toraks Kardiovaskular, Departemen Ilmu Bedah

Fakulatas Kedokteran Universitas Hasanuddin/RSUP Wahidin Sudirohusodo Makassar
 Blunt Vascular Injury Penetrating

 There has been an increase in the incidence of vascular

injury over the past four decades that has paralleled the
increase in assault with firearms, motor vehicle crashes,
and invasive medical procedures.

Caps MT, The epidemiology of vascular trauma. University of Washington, Department of Surgery, Seattle 98195-6410, USA..
 General Principles
 Always start with ABC
 Large IV pore lines
 External compression to control bleeding
 Look for hard signs of arterial injuries
 Hard Sign and Soft Sign

Further
Exploration Investigations
 Diagnostic Tools ?
 Duplex USG
 CT angiography
 Arteriography
 What should you do in OR?

 Always establish good exposure

 Establish proximal then distal arterial control
 Use a shunt if the bones need to be fixed first to buy you
some time
 Use local heparin flush
 Make your arterial repair tension-free
 Use autogenous vein
 Repair concomitant venous injury if patient is stable

Annu Babu, Harshit Garg. Penetrating neck injury: Collaterals for another life after ligation of common
carotid artery and subclavian artery.. 2015. India
Annu Babu, Harshit Garg. Penetrating neck injury: Collaterals for another life after ligation of common
carotid artery and subclavian artery.. 2015. India
Xiao-lei Wang, MD,* Zhen-gang Xu, MD, Ping-zhang Tang, MD. Tracheo-innominate artery fistula: Diagnosis and surgical management..
2012. Beijing
Bypass Graft
Endovascular Management
 Damage control
 Arteries that can be ligated with few
consequences:
- ICA ligation : high stroke rate.
- Subclavian, axillary, brachialis artery, EIA,CFA
& SFA: high risk of limb ischemia.
- SMA & IMA : gut necrosis
 Neck Trauma
 Most commonly penetrating type.
 Associated vascular injury in > 30%
•Airway
•Blood vessels
•Nerves
•Gastrointestinal
tract
 Surgical Incisions

Yohei Okada*, Hiromichi Narumiya, Wataru Ishii. Damage control management of innominate
artery injury with tracheostomy. 2016. Kyoto Japan
Yohei Okada*, Hiromichi Narumiya, Wataru Ishii. Damage control management of innominate
artery injury with tracheostomy. 2016. Kyoto Japan
 Complication of
artery communis ligation
 Cerebral Thrombus and emboly
 Hemiparesis and hemiplegia
 Aphasia
 Transient Ischemic Attack
 Blindness
 Persistent Dental Pain
Vinu Perinjelil*, Leo Mercer. Ligate to Live: Stab Wound to the Neck with Major Vascular Injuries
2017. Michigan State University, USA
Yohei Okada*, Hiromichi Narumiya, Wataru Ishii. Damage control management of innominate
artery injury with tracheostomy. 2016. Kyoto Japan
Ligation of the innominate artery could be considered as the first choice of treatment, as previous
articles stated that such flow interruption would not yield significant neurological or vascular
complications because of collateral flow through the external carotid artery, thyrocervical trunk, and
vertebral vessels.
Annu Babu, Harshit Garg. Penetrating neck injury: Collaterals for another life after ligation of common
carotid artery and subclavian artery.. 2015. India
 A Case
 A 18 years old male, suddenly he hit by arch by
unknown person from left side.
Radiology Exm.
Intra Operatve
Post Operative
Thank You
Jayarasti Kusumanegara
Thoracic, Cardiac, Vascular Surgeon