Vertebral artery trauma: acute recognition and treatment

Area of Science:

• Vascular Surgery
• Trauma Surgery
• Cervical Spine Injuries

Background:

• Vertebral artery injury (VAI) is an uncommon complication of neck trauma.
• Delayed sequelae such as arteriovenous fistulae and pseudoaneurysms can occur months post-injury.
• The incidence and long-term outcomes of VAI sequelae remain largely unknown.

Purpose of the Study:

• To evaluate the incidence and outcomes of vertebral artery injuries.
• To present a surgical technique for managing isolated VAI.
• To assess the morbidity associated with VAI treatment.

Main Methods:

• Retrospective review of 13 patients with penetrating neck trauma.
• Cervical angiography for diagnosis of vertebral artery injuries.
• Surgical ligation of the vertebral artery (proximal and distal).

Main Results:

• Vertebral artery injuries were readily identified with cervical angiography.
• Treatment of isolated VAI demonstrated low associated morbidity.
• A technique for proximal and distal ligation was successfully applied.

Conclusions:

• Isolated vertebral artery injuries can be managed with low morbidity using surgical ligation.
• Proximal and distal ligation is recommended for VAI when the contralateral artery is normal and spinal cord perfusion is not compromised.
• Early recognition and treatment are crucial for preventing delayed sequelae.