Vascular Injuries Secondary to Penetrating Neck Trauma

Abstract

Objectives

Penetrating neck trauma with vascular injury can have significant morbidity. Our goal was to examine the management and outcomes of vascular injuries secondary to penetrating neck trauma.

Methods

A single-center retrospective study identified patients with penetrating neck trauma with vascular injury (2014-2024). Injury characteristics, management, and subsequent morbidity were analyzed.

Results

There were 47 patients with penetrating neck trauma and associated vascular injury. The average age was 37.5 years, 80.9% were male, and 57% were of Black race. Mechanisms were stabbing (57.4%), firearm (34%), and other causes, including dog bites (8.5%). Vascular injuries were arterial (23.4%), venous (51.1%), and combined arterial/venous. Concurrent aerodigestive injuries occurred in 23.4% of cases. Median time from injury to emergency department (ED) presentation was 20 minutes, with 48.9% intubated enroute or on arrival. There were 72.3% that had an emergency intervention with median time to operating room of 35-minutes. Open arterial repairs included 10% carotid artery bypass, 35% carotid artery repair, and 55% arterial ligation of neck arteries. Open venous repair included 93.1% ligation and 13.8% primary vein repair. Endovascular interventions were vertebral (67%) and inferior thyroid artery (33%) embolizations. There were 12.8% of patients who died soon after presentation (67% trauma bay and 33% in the operating room), and 12.8% suffered a stroke. There were no 30-days or 1-year deaths after discharge, but 25% of patients had at least one 30-days ED visit. Follow-up imaging was received by 66% of discharged patients with an arterial repair.

Conclusions

Penetrating neck trauma with vascular injuries require prompt operative repair and are associated with high initial mortality and stroke rate. Combined arterial and venous injuries are common, and aerodigestive injuries should be considered during initial presentation. High rates of ED utilization post-discharge suggest the need for improved follow-up in this patient population.