Iatrogenic vertebral artery injury

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Neurosurgery

Background:

• Iatrogenic vertebral artery injury (VAI) is a rare but serious complication of various diagnostic and therapeutic procedures.
• Early detection and precise management are essential to prevent devastating outcomes.

Purpose of the Study:

• To provide an updated review on the mechanisms of injury and management of iatrogenic VAI.
• To categorize VAIs based on the responsible diagnostic or therapeutic procedure.

Main Methods:

• A comprehensive literature search was conducted using PubMed.
• Iatrogenic VAIs were categorized by procedure: central venous catheterization, cervical spine surgery, chiropractic manipulation, diagnostic cerebral angiography, percutaneous nerve block, and radiation therapy.

Main Results:

• Injury types varied by procedure: laceration (catheterization, surgery), dissection (manipulation, angiography), arterial injection complications (nerve block), and endothelial injury leading to stenosis/occlusion (radiation).
• Delayed complications included arteriovenous fistulae and pseudoaneurysms.
• The proximal vertebral artery (VA) is the most vulnerable segment.

Conclusions:

• Iatrogenic VAI, though rare, may be underdiagnosed; a high index of suspicion is necessary for early detection.
• Knowledge of VA surgical anatomy is vital for preventing iatrogenic injuries.
• Management strategies should be tailored to the specific injury mechanism and procedure.