Forty-three cases of vertebral artery trauma.

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.