Novosti
Khirurgii
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Year 2019 Vol. 27 No 5

CASE REPORTS

DOI: https://dx.doi.org/10.18484/2305-0047.2019.5.574   |  

S.A. KUSHTUMOV 1, 2, S.A. ATAMANOV 1, E.V. SHINKEVICH 1, P.I. MURAVIEV 1, A.G. MAKEEV 1, 2, E.G. GRIGORYEV 2, 3

HYBRID HEMOSTASIS IN STAB WOUND OF THE VERTEBRAL ARTERY, COMPLICATED BY A FALSE ANEURYSM

Irkutsk State Clinical Hospital 1,
Irkutsk State Medical University 2,
Irkutsk Scientific Centre of Surgery and Traumatology 3, Irkutsk
The Russian Federation

The article reports the staged management of a patient with stab wound of the neck, the injury of the left vertebral artery in the transverse processes canal of the cervical spine and the injury of the internal jugular vein. Emergency care in the district hospital included surgical debridement and wound canal revision, as well as the closure of the anterior wall of the internal jugular vein. On the fifth postoperative day, a tumor-like soft pulsating painful mass was detected above the clavicle. Auscultation revealed a systolic murmur. The patient was moved to the vascular surgery department of the regional hospital. MSCT-angiography showed a saccular mass lesion 40×30×23 mm with irregular contours at the level of C3-C4 vertebrae - false arteriovenous aneurysm. During the surgical wound exploration and aneurysm opening, arterial bleeding from the injured artery occurred. Temporary bleeding arrest was performed by tamponade of the bone defect with wax. The final hemostasis was achieved by X-ray-endovascular occlusion of the vertebral artery using catheter retrograde and antegrade spiral and amplatzer techniques. In the postoperative period, ultrasound study revealed subcutaneous fluid mass in the area of postoperative suture. After removing the sutures, 30 ml of lysed blood and clots were evacuated.
The patient was discharged in a satisfactory condition on the 13th postoperative day. Examination in two months revealed no complaints. Physical activity is in full volume. There are no violations of the quality of life.

Keywords: stab wound, vertebral artery, internal jugular vein, posttraumatic aneurysm, endovascular hemostasis
p. 574-578 of the original issue
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Address for correspondence:
664003, The Russian Federation,
Irkutsk, Krasnogo Vosstaniya Str., 1,
Irkutsk State Medical University,
Hospital Surgery Department.
Tel. +7 9025 111 027,
e-mail: egg@iokb.ru,
Eugene G. Grigoryev
Information about the authors:
Kushtumov Sergei A., PhD, Assistant of the Hospital Surgery Department, Irkutsk State Medical University, Head of the Vascular Surgery Department, Irkutsk State Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0003-4630-1274
Atamanov Sergey A., PhD, Specialist on X-ray Endovascular Diagnostics and Treatment, Irkutsk State Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0002-9660-3740
Shinkevich Eduard V., PhD, Cardiovascular Surgeon of the Vascular Surgery Department, Irkutsk State Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0002-2729-4278
Muraviev Pavel I., Cardiovascular Surgeon of the Vascular Surgery Department, Irkutsk State Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0002-9061-0544
Makeev Alexander G., PhD, Associate Professor of the Human Anatomy Department, Irkutsk State Medical University, Cardiovascular Surgeon of the Vascular Surgery Department, Irkutsk State Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0002-4512-2656
Grigoryev Eugene G., MD, Professor, Corresponding Member of RAS, Supervisor, Irkutsk Scientific Centre of Surgery and Traumatology, Head of the Hospital Surgery Department, Irkutsk State Medical University, Head of the Vascular Surgery Department, Irkutsk State Clinical Hospital, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-5082-7028
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