Penetrating Cervical Vascular Injuries

Abstract

This article reviews penetrating cervical vascular injuries, with a focus on the initial control, diagnostic workup, and operative or endovascular management. The review highlights the change in management approach from one based on anatomical zones of the neck to the contemporary approach of using physical exam and computed tomographic angiography to guide decision making. The approach to penetrating neck injuries has evolved over the past 40 years with a resultant decrease in the rate of non-therapeutic operations, driven primarily by improvements in imaging technology. The role of endovascular techniques is now established for vertebral artery injuries and continues to evolve for non-emergent carotid injuries. Penetrating cervical injuries pose a significant risk to life and triage of patients to the operating room or further imaging by computed tomographic angiography (CTA) must occur promptly based on the physical examination. In the operating room, the management of complex venous injuries consists of simple ligation. Vertebral injuries can be temporized with packing or bone wax and then managed with percutaneous endovascular interventions. Carotid injuries may generally be managed with arteriorrhaphy, primary repair, or reconstruction with venous or PTFE graft. In damage control situations, shunting is preferred.