37615 Ligation, major artery (eg, post-traumatic, rupture); neck

Name of the Procedure:

Ligation of a Major Artery in the Neck (e.g., post-traumatic rupture)

Summary

This procedure involves tying off a major artery in the neck to stop bleeding, typically in emergency situations like severe trauma or arterial rupture.

Purpose

Ligation of a major artery in the neck is performed to control severe bleeding that can be life-threatening. The primary goal is to stop the hemorrhage, stabilize the patient, and prevent further complications such as shock or death.

Indications

• Severe neck trauma with arterial bleeding
• Ruptured artery due to injury or other causes
• Cases where less invasive measures to control bleeding are ineffective

Preparation

• The patient will need to fast for several hours prior to the procedure.
• Pre-procedure blood tests, imaging studies (like CT or ultrasound), and an assessment of overall health will be conducted.
• Consent will be obtained after explaining the risks and benefits.

Procedure Description

1. The patient is prepped and draped in a sterile manner.
2. General anesthesia is administered to ensure the patient is unconscious and free of pain.
3. The surgeon makes an incision in the neck to access the artery.
4. The artery is identified, isolated, and sutured or tied off to stop the bleeding.
5. The incision is closed with sutures.
6. The patient is monitored for any immediate complications.

Duration

The procedure typically takes 1-2 hours, depending on the severity of the situation and the patient's condition.

Setting

This procedure is performed in a hospital operating room, where emergency and surgical facilities are available.

Personnel

• Vascular surgeon or trauma surgeon
• Anesthesiologist
• Surgical nurses
• Support staff (possibly including a scrub tech and radiology technician)

Risks and Complications

• Infection at the surgical site
• Damage to surrounding structures (nerves, veins, other arteries)
• Ischemia (lack of blood supply) to areas beyond the ligated artery
• Blood clots
• Adverse reactions to anesthesia

Benefits

The primary benefit is stopping life-threatening bleeding, which can save the patient's life. Patients generally stabilize quickly once bleeding is controlled.

Recovery

• Post-operative care includes pain management, monitoring for complications, and possible antibiotics to prevent infection.
• The patient may need to stay in the hospital for a few days.
• Activity will be restricted for several weeks, and follow-up appointments will be necessary to monitor recovery.

Alternatives

• Endovascular techniques to control bleeding (less invasive but may not be suitable for all cases)
• Conservative management (e.g., pressure dressings) in less severe cases
• Blood transfusions and fluid resuscitations to manage shock without surgical intervention

Pros of Endovascular Techniques:

• Less invasive
• Faster recovery time

Cons:

• May not be effective in all cases

Patient Experience

During the procedure, the patient will be under general anesthesia and should not feel pain. Post-procedure, the patient may experience pain at the incision site, managed with medication. Some swelling and bruising are expected. Patients might feel weak or fatigued as they recover from both the surgery and the initial trauma. Comprehensive care and close monitoring help ensure comfort and recovery.