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Abstract
Through a planned program of anticipation and repeated orientation of all surgical
personnel to the problems and procedures to be followed, seventeen of nineteen instances
of massive spontaneous hemorrhage of the carotid artery have been successfully controlled.
The restoration and stabilization of the patient's vital signs by point-pressure control
of bleeding, maintenance of adequate ventilation, and rapid blood volume restoration,
together with the emergency mobilization of hospital facilities, have allowed all
but three of these patients to undergo successful ligation. No neurologic defects
have resulted, and all have been restored to their prior “blowout” ambulatory status.
Removal of a portion of the medial clavicle often facilitated ligation and wound closure.
The common etiologic factor in this series of spontaneous hemorrhage of the carotid
artery has been the combination of surgery for postirradiation recurrent cancer which
was subsequently followed by wound breakdown secondary to tissue necrosis or fistula
formation. In addition, tumor either grossly or microscopically has been present in
at least seven instances. Three carotid artery hemorrhages in two patients occurred
from infection alone after radical surgery.
The incidence of spontaneous hemorrhage of the carotid artery has significantly decreased
since, at the time of surgery, skin incisions overlying the carotid are avoided, all
carotids are routinely covered with muscle flaps, and antibiotic prophylaxis is employed.
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References
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- Les accidents cérébraux et oculaires consécutifs à la ligature de la carotide primitive.Étude expérimentale et clinique, Thesis No. 292. 1906; (Paris)
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- The prevention of carotid artery hemorrhage by the use of rotating tissue flaps.Surgery. 1953; 34: 186
- Rupture of the carotids following radical neck surgery in radiated patients.Ear, Nose & Throat Monthly. 1962; 41: 531
- A muscle cover for the carotid artery after radical neck dissection.Am. J. Surg. 1961; 102: 815
Article info
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© 1965 Published by Elsevier Inc.
