Extraluminal, transluminal, and observational treatment for vertebral artery injuries

Injury to the vertebral artery following penetrating trauma is rare and treatment is usually surgical ligation. Recent liberal use of angiography in the evaluation of penetrating neck trauma has identified increasing numbers of patients with this challenging injury. This report describes our recent experience in treating patients with vertebral artery injuries. The purposes of this study were (1) to review the outcome of our patients with vertebral artery injuries, and (2) to develop an approach for managing these patients. Sixteen patients were treated over a 9-year period. Three patients underwent emergent operative exploration for bleeding, three underwent transcatheter embolization alone, and ten were managed conservatively by close clinical observation. No deaths occurred. Ligation was performed for injuries discovered during neck exploration, however, bleeding was sometimes persistent despite proximal control. In our center, where radiological support is readily available, temporary control of bleeding by packing with hemostatic agents allowed subsequent transcatheter embolization of the injured artery. Pseudoaneurysms, arteriovenous fistulae, and extravasations discovered angiographically were usually managed by transcatheter embolization. Patients with vertebral artery narrowings or occlusions were managed by close clinical observation.