Traumatic Vascular Lesions

Trauma occurring to the head and neck can be due to a blunt injury (such as an object striking the head or neck) or a penetrating trauma (involving an object piercing the head or neck). When trauma takes place in this region, it can result in damage to the arteries and veins in that area.

Damage to an artery can result in severe bleeding, as well as other complications. For example, a pseudoaneurysm may develop. This occurs when a blood clot expands around the hole in the vessel. The clot from a pseudoaneurysm can produce pressure on surrounding structures, which can affect breathing and swallowing.

An abnormal connection between the two may develop, which results in the blood flowing from the artery through the hole in the vein.

Although they may not occur immediately after the injury, another complication from a traumatic vascular lesion can be an arteriovenous fistula. This results when there is damage to both the artery and the vein. An abnormal connection between the two may develop, which results in the blood flowing from the artery through the hole in the vein, back to the heart, instead of the brain.

Damage to an artery can also occur, leading to partial blockage of the artery. This can result in a reduced blood flow to the brain as well as the formation of blood clots. The blood clots can break off and travel to the brain, resulting in strokes.

Surgery is sometimes recommended in the treatment of traumatic vascular lesions. For example, surgery is the treatment of choice when the carotid artery is injured and bleeding. However, some types of vascular trauma cannot be treated with surgery. When surgery is too high risk, embolization may be recommended.

This procedure is similar to an angiogram, in which a catheter or tube is inserted into the leg and x-ray technology is used to guide the catheter to the damaged blood vessels. Materials can then be injected to block off the hole.

The embolization procedure from start to finish
Prior to undergoing embolization, patients are expected to sign a consent form and will have the opportunity to have questions answered. The anesthesiologist will administer medications and fluids through the use of an intravenous line (IV) into a vein in the hand or arm. He or she will also administer general anesthesia so that the patient will be completely asleep for the procedure. Blood pressure will be monitored through an A-Line, a thin flexible tube or catheter placed in an artery in your wrist. An electrocardiogram (EKG) will monitor heart rate and rhythm as well as oxygen levels. A specific type of catheter known as a Foley will be placed in the bladder to allow urine to drain.

Once the procedure is complete, the patient will be transferred from the operating room to either the Surgical Intensive Care Unit (SICU) or the Post-Anesthesia Care Unit (PACU). Here, a heart monitor will closely monitor vital signs. This machine is very sensitive and often sounds inadvertently; this is not cause for alarm. The nursing staff will assist in changing positions, but bed rest is required. Eventually, the patient can look forward to a normal diet and transfer to a room on a surgical floor. The Foley catheter will also be removed prior to leaving the bed for the first time.

Patients are expected to keep the leg that underwent surgery straight for several hours and a tube may remain in place at the puncture sight for several days. Once it is removed, the physician will apply pressure for about 20 minutes to prevent bleeding, and a device may be used to seal the puncture.

When a hole is present in the main artery along with a surrounding clot, the placement of a stent may be recommended. A stent is a metal device that is inserted in order to hold open the vessel. It is placed across the hole by a catheter, similar to the procedure conducted in an angiogram. Once the stent is in place, embolization may then occur by injecting material in to the hole and the clot, causing it to fill up clot completely.

When a fistula, or abnormal connection between the vein and artery is present, a catheter may be placed into the connection and material is injected to close the connection.

In other instances, an artery must be blocked off in order to treat an injury to it. In this case, a catheter with a small balloon on it is inserted into the vessel. The balloon is inflated and expands within the vessel, preventing further flow of blood. Test occlusion then is conducted – the process of checking the patients every few minutes to determine if the blockage has caused symptoms. If no symptoms result, material is injected through a catheter to block the vessel.