Imaging of Traumatic Arterial Injuries to the Cervical Vessels

Abstract

Trauma involving the cervical region can result in either blunt or penetrating injury to the cervicocerebral vessels, with attendant hemorrhagic and/or neurologic sequelae. The reported incidence of carotid or vertebral artery injury in all trauma patients is 1.2–1.6 %, with an associated risk of acute cerebral ischemia in 12–15 % of affected individuals. Blunt cervical vascular injury (BCVI) is increased in the setting of cervical spine, basilar skull, or severe facial fractures; spinal cord and traumatic brain injury; major thoracic injuries; and cervical hyperextension/rotation or hyperflexion. The vertebral artery is more commonly injured than the carotid artery because of its close proximity to bone as it runs through the intervertebral foramina. Twenty percent of BCVI patients, however, demonstrate none of these “classic” risk factors. Damage from penetrating cervical vascular injury (PCVI) trauma is less common than blunt trauma, with carotid and vertebral artery injuries accounting for only 3 % and 0.5 %, respectively, of arterial injuries in civilians.