Vertebral artery trauma: acute recognition and treatment.

Vertebral artery injury is uncommon and may be initially unrecognized. Sequelae of vertebral artery injury include arteriovenous fistulae and pseudoaneurysms that may appear months after injury. The incidence of the sequelae is unknown. Cervical angiography used in the routine evaluation of a patient with penetrating neck trauma readily demonstrates vertebral artery injuries. This series of 13 cases demonstrates the low morbidity associated with the treatment of isolated vertebral artery injuries. A technique for proximal and distal ligation of the vertebral artery is presented. Its use is recommended in the treatment of any patient with vertebral artery injury who has a normal contralateral vertebral artery and no demonstrable extracranial branches from the vertebral artery to the spinal cord.