Blast injury to the common carotid artery in a soldier wounded in the war in Ukraine

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Abstract
Aim: Penetrating blast injuries to the neck carry a high risk of mortality due to the presence of vital structures. Common carotid artery (CCA) injuries require urgent management to prevent exsanguination or ischemic complications. Temporary shunting is often preferred in ROLE 2 (NATO medical role system) military settings, as it reduces stroke and mortality rates. However, in cases where vascular ex-pertise is limited, CCA ligation may be a safer and faster alternative, as it minimizes the risk of distal embolization. This case report presents a combat-related CCA injury and the rationale for ligation over shunting in a ROLE 2 envi-ronment.Methods: A 35-year-old soldier sustained a blast injury to the neck and was evacuated to a front surgical team with signs of major vascular damage. Surgery identified injuries to the right CCA and vertebral artery. Due to the risk of em-bolization and limited vascular expertise, CCA ligation was performed instead of temporary shunting. The patient was stabilized and transferred to ROLE 3 for definitive repair, where autologous vein grafting was successfully performed.Results: Temporary shunting is the preferred approach for maintaining cerebral perfusion but requires vascular ex-pertise and carries the risk of embolization. In resource-lim-ited combat settings, ligation provides rapid hemorrhage control and facilitates faster evacuation. This case demon-strates that CCA ligation can be an effective damage control strategy when shunting is not feasible. The patient recov-ered well, with minimal postoperative complications.Conclusions: Combat-related CCA injuries require rapid de-cision-making based on available resources and expertise. While temporary shunting is ideal, ligation is a practical al-ternative in ROLE 2 settings where vascular specialists are unavailable. This case highlights the need for adaptive sur-gical strategies in military trauma care.

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