Current Management of Penetrating Traumatic Cervical Vascular Injuries

Abstract

Penetrating neck injuries constitute 5–10% of all emergency trauma presentations and are associated with a relatively high risk of mortality. The most common significant injury encountered in penetrating neck trauma is injury to the vasculature of the neck. This article reviews penetrating cervical vascular injuries, including initial assessment, immediate, and definitive management techniques. Assessment and management of penetrating injuries to the neck have traditionally been approached according to the location of the injury in relation to anatomic zones of the neck. More recently, due to advancements in imaging techniques and endovascular therapies, there is a trend towards non-operative management. This has resulted in a decrease in the rate of non-therapeutic surgeries. Penetrating traumatic cervical vascular injuries are potentially life-threatening and require appropriate clinical assessment to rapidly identify patients who need immediate surgical intervention. However, patients without hard signs of vascular injury should undergo imaging, most commonly in the form of computed tomographic angiography. For patients who require operative intervention, surgical techniques include vessel ligation, direct repair or angioplasty, interposition grafts, and damage control procedures. Endovascular techniques are particularly useful in the management of vascular injuries of the vertebral artery.