A New Approach to the Treatment of Penetrating Injuries to the Vertebral Artery

Abstract

Penetrating injuries to the vertebral artery remain an unusual, yet challenging, problem in trauma patients. Once thought to be rare, the awareness of this type of injury is increasing, in part because of arteriography for patients with penetrating cervical trauma. Mortality rates have been reported from 5-50% in various reviews. Early and late complications are common and often life-threatening. These include bleeding, pseudoaneurysm, arteriovenous fistula, thrombosis, and stroke. In addition, distal vertebral artery trauma represents a distinctly more complex and technically challenging problem. Standard surgical practice has been operative ligation (proximal and distal) and/or direct repair of the injured vessel. However, surgical exposure and repair of the injured vessel is often technically difficult, especially when the upper cervical portion of the artery is involved. Interventional radiologic techniques are now being used to diagnose and treat many complex vascular injuries. A new treatment for a Zone III vertebral artery gunshot wound is presented here. Using endovascular techniques the authors were able to successfully occlude the proximal vertebral artery via an ipsilateral approach, and the distal vertebral artery via a contralateral approach. This unique application of nonoperative interventional technique has significant implications for vascular surgery. This report represents the first successful treatment of a Zone III vertebral artery occlusion treated by endovascular methods.