Blunt vertebral vascular injury in trauma patients: ATLS® recommendations and review of current evidence

Abstract

Blunt cerebrovascular injury (BCVI) encompasses two distinct clinical entities: traumatic carotid artery injury (TCAI) and traumatic vertebral artery injury (TVAI). The latter is the focus of our review. These are potentially devastating injuries which pose a diagnostic challenge in the acute trauma setting. There is still debate regarding the optimal screening criteria, diagnostic imaging modality and treatment methods. In 2012 the American College of Surgeons proposed criteria for investigating patients with suspected TVAI and subsequent treatment methods, caveated with the statement that evidence is limited and still evolving. Here we review the historical evidence and recent literature relating to these recommendations.

Keywords: Blunt; blunt cerebrovascular injury (BCVI); injury; trauma; vascular; vertebral; vertebral artery injury (VAI).

Figure 1

Vertebral Artery Anatomy. A, aorta; B, basilar artery; C, common carotid artery; SC, subclavian artery; V, vertebral artery. Segments of the path of the vertebral artery; V1, preforaminal; V2, foraminal; V3, atlantoaxial; V4, intradural.

Figure 2

The Circle of Willis. VA, vertebral artery; B, basilar artery; PCA, posterior cerebral artery; IC, internal carotid artery; MCA, middle cerebral artery; ACA, anterior cerebral artery; ANCA, anterior communicating artery; OA, ophthalmic artery.