On September 30, Xijing Hospital in Xi’an faced a critical situation when a construction worker, known only as Liu Ming, was rushed in with a severe injury to his carotid artery. Reports indicate that Liu was struck in the neck by a metal object that dislodged from a pile driver during his work. His colleagues quickly took him to a nearby hospital but, due to significant blood loss and signs of hemorrhagic shock, he was swiftly referred to Xijing Hospital for more advanced medical intervention.

Upon his arrival, Liu’s condition was alarming; he had lost a considerable amount of blood and his skin was notably pale. The cardiovascular surgical team immediately admitted him to the intensive care unit, where they initiated rapid fluid resuscitation to stabilize his vital signs.

Dr. Duan Weixun, the deputy chief surgeon in the cardiovascular department, explained the severity of carotid artery injuries. “These injuries are particularly dangerous because of their complex anatomical location,” he noted. “Damage can cause hematoma formation, which may obstruct the airway leading to suffocation, and it can also result in severe ischemia of the brain, potentially causing long-term disability or even death. This is why carotid artery injuries are deemed extremely critical and present significant treatment challenges.”

Understanding the urgency, an expert team quickly convened for an emergency multidisciplinary consultation. Given the complexity of Liu’s injury and the difficulty in pinpointing the trauma, imaging revealed a pattern of metal debris without a distinct shape, while three-dimensional reconstruction displayed a complete loss of blood supply to the left common carotid artery.

During the surgery, the team encountered multiple hurdles, including the risk of massive hemorrhage and cardiac arrest. Dr. Duan highlighted the importance of collaboration, stating that the experts worked closely together to devise a surgical plan that included contingency strategies to mitigate risks and achieve the best possible outcome for Liu. Ultimately, they opted for a complex surgical procedure that involved replacing the left common carotid artery with an artificial graft and reconstructing both the left internal jugular vein and the vertebral artery.

As the surgery progressed, Dr. Duan’s team carefully navigated through the neck incision, layer by layer. They faced significant challenges, including a substantial amount of clotted blood that obstructed their view. As they cleared the clots, Liu suddenly experienced a burst of bleeding from the carotid artery, which led to fluctuations in his blood pressure and heart rate. In a swift response to this emergency, Dr. Duan applied clamps to the ruptured ends of the carotid artery to control the bleeding, then continued to assess the injury. It revealed that the left common carotid artery was nearly severed, with only about 3mm of tissue remaining, while the left internal jugular vein was 3/5 compromised.

Despite these daunting challenges, the medical team pressed on. After careful exploration of about 6 centimeters, they located a dark metal object embedded in the surrounding tissue, ultimately identifying it as a piece measuring 12mm x 10mm x 3mm.

Once the source of the injury was removed, the team carried out thorough debridement and suturing. Following the surgery, Liu was moved to the monitoring unit for observation, where his vital signs stabilized. Remarkably, he was extubated the night of the surgery and was walking the very next day. His surgical site healed well, without any short-term complications, and he was discharged from the hospital fully recovered.