Management of penetrating cervicomediastinal venous trauma

Abstract

Objectives: to evaluate the results of management of penetrating cervicomediastinal venous trauma. Design: retrospective study. Materials: forty-nine consecutive patients with cervical and thoracic venous injuries treated at a tertiary hospital between 1991 and 1997. Method: patients identified from a computerised database and data extracted from case records. Results: forty-five patients were male and the mean age was 25.3 years. Forty injuries were due to stabs and 9 to gunshots. 22 patients were shocked, 25 actively bleeding and 31 were anaemic. Veins injured were internal jugular in 25, subclavian in 15, brachiocephalic in 6, and superior vena cava in 3. Injured veins were ligated in 25 cases and repaired by lateral suture in 22. No complex repairs were performed. There were 8 perioperative deaths and 5 cases of transient postoperative oedema. Venous ligation was not associated with increased risk of postoperative oedema. Conclusions: ligation is an acceptable form of treatment of cervicomediastinal venous injuries in the presence of haemodynamic instability, or where complex methods of repair would otherwise be necessary.