Outcomes for cervicomediastinal vascular trauma managed by a vascular subspecialist- led vascular trauma service VASCULAR SURGERY

VOL. 54 NO. 2 JUNE 2016 SAJS Cervicomediastinal vascular injuries may be caused by blunt or penetrating trauma, and collectively constitute 5–10% of all reported cases of vascular trauma.1,2 The operative management of cervicomediastinal vascular trauma is challenging as surgical access is difficult, and loss of control can result in rapid exsanguination. High morbidity and the mortality rates, ranging from 14–25%, have been cited in both South African and international reports.3–7 Blunt thoracic aortic injury is immediately fatal in 80–90% of cases, and if untreated, survivors have a dismal prognosis. Thirty per cent die within six hours, 40–50% within 24 hours and 90% within four months, while overall operative mortality is approximately 28%, with a systemic complication rate of 50%.8,9 Penetrating thoracic aortic trauma is highly lethal, and the mortality rate can be as high as 80%.10 New techniques have been introduced over the last two decades with the rapid development of endovascular surgery, and offer potential solutions to complex injuries while avoiding the risk of open surgery.11 This makes decisionmaking more nuanced and complex. Our parent vascular surgery department in Durban pioneered the concept of a dedicated metropolitan vascular trauma service over three decades ago in response to the complex nature of these injuries and their relative rarity.12,13 The spectrum and outcomes of cervicomediastinal vascular trauma in our newly established vascular trauma team are reviewed in this report, and a comparison made with those in Durban, while attempting to contextualise the new and emerging endovascular and imaging techniques with a more established approach. Outcomes for cervicomediastinal vascular trauma managed by a vascular subspecialistled vascular trauma service VASCULAR SURGERY