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Forty-three cases of vertebral artery trauma
1Department of Surgery, Southwestern Medical School, University of Texas Health Science Center, Dallas 75235.
Insights
Injuries to the vertebral artery, often from penetrating trauma, can cause severe bleeding but rarely lead to stroke. Prompt surgical repair is key to survival and preventing complications.
Area of Science:
- Traumatology
- Vascular Surgery
- Neurosurgery
Background:
- Vertebral artery injuries are uncommon but potentially life-threatening, typically resulting from penetrating neck trauma like gunshot or stab wounds.
- While associated with cervical spine fractures and neural damage, vertebral artery injuries do not typically cause vertebral-basilar ischemic events.
Purpose of the Study:
- To review cases of vertebral artery injury to understand injury patterns, associated injuries, treatment outcomes, and mortality.
- To evaluate the effectiveness of diagnostic methods and surgical interventions for vertebral artery trauma.
Main Methods:
- Retrospective review of 43 cases with vertebral artery injury.
- Analysis of patient demographics, injury mechanisms, associated injuries, diagnostic findings (arteriography), treatment strategies, and patient outcomes.
Main Results:
- The majority of patients were hemodynamically stable despite potential for severe hemorrhage.
- Vertebral artery injury frequently co-occurred with cervical spine fractures and local neural deficits, but no vertebral-basilar ischemia was observed.
- Arteriography was accurate in identifying injury location, though specific diagnoses could be unreliable. Proximal vascular control alone had a 15% complication rate.
Conclusions:
- Direct surgical intervention, including proximal and distal arterial ligation, is the standard treatment for acute vertebral artery injuries.
- Conservative management may be suitable for minimal injuries.
- Low mortality (4.7%) was attributed to accurate diagnosis and timely surgical intervention.
Abstract:
Forty-three cases of injury to the vertebral artery are reviewed. Trauma to these cervical vessels requires deep tissue penetration, most often as a result of gunshot or stabwounds. The majority of patients are hemodynamically stable, although serious hemorrhage and death may result from injury to this artery alone. Injury to the vertebral artery was frequently associated with cervical spine fracture and local neural damage. However, no patient presented with or developed neurologic sequelae attributable to vertebral-basilar ischemia. Arteriography accurately identified the site of injury, but the specific arteriographic diagnosis can be unreliable. Two of 13 patients (15%) treated by proximal vascular control alone had postoperative vascular complications. While direct surgical intervention with proximal and distal arterial ligation is the appropriate treatment of acute injuries, in some cases there may be a role for conservative treatment of minimal injuries. In this series, mortality related to a vertebral artery injury was low (4.7%), likely as a result of accurate diagnosis and prompt operative intervention.