Vascular Injuries of the Neck

  • Stefano PirrelliEmail author
  • Pietro Quaretti
  • Lorenzo Moramarco
  • Vittorio Arici
  • Antonio Bozzani
  • Riccardo Corti


The incidence of traumatic injuries in civil practice ranges from 3.5 to 8.2% of total arterial lesions, being in detail the following: for 0.2% for single vessels, 3% for brachiocephalic lesions, 3–4.5% for subclavian artery, 5.2–8.2% for carotid artery, and 0.7–1% for vertebral artery. Under an etiologic point of view, the traumatic injuries are often localized to the front of the neck and the upper chest, mainly due to penetrating lesions (80% of cases), contusions (3–10% of cases), and iatrogenic (10% of cases) with differences depending on the vessel affected by the trauma. The diagnosis is mainly based on the analysis of trauma mechanism, the presence of skin lesions, and the CT scan results. Often they are associated with other scheletric lesions and visceral lesions which can minimize the effect of vessel trauma, especially in blunt injuries. The endovascular approach is the treatment of choice, with particular attention to the endovascular control of bleeding and treatment also if the “open” surgical treatment may be beneficial especially in carotid injuries.


  1. 1.
    White JM, Stannard A, Burkhardt GE, Eastridge BJ, Blackbourne LH, Rasmussen TE. The epidemiology of vascular injury in the wars in Iraq and Afghanistan. Ann Surg. 2011;253:1184–9.CrossRefGoogle Scholar
  2. 2.
    MacLeod JB1, Cohn SM, Johnson EW, McKenney MG. Trauma deaths in the first hour: are they all unsalvageable injuries? Am J Surg. 2007;193:195–9.CrossRefGoogle Scholar
  3. 3.
    Rasmussen TE, Clouse WD, Jenkins DH, Peck MA, Eliason JL, Smith DL. The use of temporary vascular shunts as a damage control adjunct in the management of wartime vascular injury. J Trauma. 2006;61:8–12.CrossRefGoogle Scholar
  4. 4.
    Fabian TC, Patton JH Jr, Croce MA, Minard G, Kudsk KA, Pritchard FE. Blunt carotid injury: importance of early diagnosis and anticoagulant therapy. Ann Surg. 1996;223:513–22.CrossRefGoogle Scholar
  5. 5.
    Duke BJ, Ryu RK, Coldwell DM, Brega KE. Treatment of blunt injury to the carotid artery by using endovascular stents: an early experience. J Neurosurg. 1997;87:825–9.CrossRefGoogle Scholar
  6. 6.
    Punjabi AP, Plaisier BR, Haug RH, Malangoni MA. Diagnosis and management of blunt carotid artery injury in oral and maxillofacial surgery. J Oral Maxillofac Surg. 1997;55:1388–95.CrossRefGoogle Scholar
  7. 7.
    National Trauma DataBank. American College of Surgeons—Committee on Trauma, Chicago, IL, 2009.Google Scholar
  8. 8.
    McConnell DB, Trunkey DD. Management of penetrating trauma to the neck. Adv Surg. 1994;27:97–123.PubMedGoogle Scholar
  9. 9.
    Carducci B, Lowe RA, Dalsey W. Penetrating neck trauma: consensus and controversies. Ann Emerg Med. 1986;15:208–15.CrossRefGoogle Scholar
  10. 10.
    Davis JW, Holbrook TL, Hoyt DB, Mackersie RC, Field TO Jr, Shackford SR. Blunt carotid artery dissection: incidence, associated injuries, screening, and treatment. J Trauma. 1990;30:1514–7.CrossRefGoogle Scholar
  11. 11.
    Biffl WL, Ray CE Jr, Moore EE, Franciose RJ, Aly S, Heyrosa MG, Johnson JL, Burch JM. Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography. Ann Surg. 2002;235:699–706.CrossRefGoogle Scholar
  12. 12.
    Biffl WL, Moore EE, Ryu RK, Offner PJ, Novak Z, Coldwell DM, Franciose RJ, Burch JM. The unrecognized epidemic of blunt carotid arterial injuries: early diagnosis improves neurologic outcome. Ann Surg. 1998;228:462–70.CrossRefGoogle Scholar
  13. 13.
    Berne JD, Norwood SH, McAuley CE, Vallina VL, Creath RG, McLarty J. The high morbidity of blunt cerebrovascular injury in an unscreened population: more evidence of the need for mandatory screening protocols. J Am Coll Surg. 2001;192:314–21.CrossRefGoogle Scholar
  14. 14.
    Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Burch JM. Blunt carotid arterial injuries: implications of a new grading scale. J Trauma. 1999;47:845–53.CrossRefGoogle Scholar
  15. 15.
    Miller PR, Fabian TC, Croce MA, Cagiannos C, Williams JS, Vang M, Qaisi WG, Felker RE, Timmons SD. Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes. Ann Surg. 2002;236:386–95.CrossRefGoogle Scholar
  16. 16.
    Ruesch S, Walder B, Tramer MR. Complications of central venous catheters: internal jugular versus subclavian access a systematic review. Crit Care Med. 2002;30:454e60.CrossRefGoogle Scholar
  17. 17.
    Golden LR. Incidence and management of large-bore introducer sheath puncture of the carotid artery. J Cardiothorac Vasc Anesth. 1995;9:425–8.CrossRefGoogle Scholar
  18. 18.
    Reuber M, Dunkley LA, Turton EP, Bell MD, Bamford JM. Stroke after internal jugular venous cannulation. Acta Neurol Scand. 2002;105:235–9.CrossRefGoogle Scholar
  19. 19.
    Monson DO, Saletta JD, Freeark RJ. Carotid vertebral trauma. J Trauma. 1969;9:987–99.CrossRefGoogle Scholar
  20. 20.
    Bell RB, Osborn T, Dierks EJ, Potter BE, Long WB. Management of penetrating neck injuries: a new paradigm for civilian trauma. J Oral Maxillofac Surg. 2007;65:691–705.CrossRefGoogle Scholar
  21. 21.
    Kohler R, Vargas MI, Masterson K, Lovblad KO, Pereira VM, Becker M. CT and MR angiography features of traumatic vascular injuries of the neck. Am J Roentgenol. 2011;196:W800–9.CrossRefGoogle Scholar
  22. 22.
    Bleazard S, Riccelli L. Imaging of traumatic vascular injuries in the neck. Semin Roentgenol. 2006;41:237–9.CrossRefGoogle Scholar
  23. 23.
    Uyeda JW, Anderson SW, Sakai O, Soto JA. CT angiography in trauma. Radiol Clin N Am. 2010;48:423–38.CrossRefGoogle Scholar
  24. 24.
    Chokshi FH, Munera F, Rivas LA, Henry RP, Quencer RM. 64-MDCT angiography of blunt vascular injuries of the neck. AJR. 2011;196:W309–15.CrossRefGoogle Scholar
  25. 25.
    Biffl WL, Moore EE, Offner PJ, Burch JM. Blunt carotid and vertebral arterial injuries. World J Surg. 2001;25:1036–43.CrossRefGoogle Scholar
  26. 26.
    Saito N, Hito R, Burke PA, Sakai O. Imaging of penetrating injuries of the head and neck: current practice at a level 1 trauma center in the US. Keio J Med. 2014;63(2):23–33.CrossRefGoogle Scholar
  27. 27.
    Key G, editor. The Apologie and treatise of Ambroise Paré containing the voyages made into divers places with many writings upon surgery. London: Falcon Education Books; 1957.Google Scholar
  28. 28.
    Makin GH. Injuries to the blood vessels. In: Official history of the great war medical services: surgery of the war, vol. 2. London: His Majesty’s Stationery Office; 1922. p. 170e296.Google Scholar
  29. 29.
    Lawrence KB, Shefts LM, McDaniel JR. Wounds of the common carotid arteries: report of seventeen cases from World War II. Am J Surg. 1948;76:29e37.Google Scholar
  30. 30.
    Hughes CW. Arterial repair during the Korean war. Ann Surg. 1958;147:555e61.Google Scholar
  31. 31.
    Fogelman MJ, Stewart RD. Penetrating wounds of the neck. Am J Surg. 1956;91:581e96.CrossRefGoogle Scholar
  32. 32.
    Higashida RT, Halbach VV, Tsai FY, Norman D, Pribram HF, Mehringer CM, Hieshima GB. Interventional neurovascular treatment of traumatic carotid and vertebral artery lesions: results in 234 cases. Am J Roentgenol. 1989;153(3):577–82.CrossRefGoogle Scholar
  33. 33.
    ATLS Subcommittee; American College of Surgeons’ Committee on Trauma; International ATLS Working Group. Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg. 2013;74(5):1363–6.Google Scholar
  34. 34.
    Demetriades D, Theodorou D, Cornwell E, Beme TV, Asensio JA, Belzberg H, Velmahos G, Weaver F, Yellin A. Evaluation of penetrating injuries of the neck: prospective study of 223 patients. World J Surg. 1997;21(1):41–8.CrossRefGoogle Scholar
  35. 35.
    Sperry JL, Moore EE, Coimbra R, Croce M, Davis JW, Karmy-Jones R, McIntyre RC Jr, Moore FA, Malhotra A, Shatz DV, Biffl WL. Western Trauma Association critical decisions in trauma: penetrating neck trauma. J Trauma Acute Care Surg. 2013;75(6):936–40.CrossRefGoogle Scholar
  36. 36.
    Demetriades D, Asensio JA, Velmahos G, Thal E. Complex penetrating neck injuries. In: Asensio JA, Demetriades D, Berne TV (eds). W.B. Saunders Co., Philadelphia. Surg Clin North Am. 1996;76(4):685–724.CrossRefGoogle Scholar
  37. 37.
    Asensio JA, Valenziano CP, Falcone RE, Grosh JD. Management of penetrating neck injuries. Surg Clin North Am. 1991;71(2):267–96.CrossRefGoogle Scholar
  38. 38.
    Asensio JA, Vu T, Mazzini F, Herrerias F, Pust GD, Sciarretta J, Chandler J, Verde JM, Menendez P, Sanchez JM, Petrone P, Marini C. Penetrating carotid artery: uncommon complex and lethal injuries. Eur J Trauma Emerg Surg. 2011;37(5):429–37.CrossRefGoogle Scholar
  39. 39.
    Ivatury RR, Stoner MC. Penetrating cervical vascular injury. In: Rich NM, Mattox KL, Hirshberg A, editors. Vascular trauma. 2nd ed. Philadelphia: Elsevier Saunders; 2004. p. 223–40.CrossRefGoogle Scholar
  40. 40.
    Rowe V, Petrone P, García-Nuñez LM, Asensio JA. Carotid, vertebral artery, and jugular venous injuries. In: Asensio JA, Trunkey D, editors. Current therapy of trauma and surgical critical care. 5th ed. Philadelphia: Mosby/Elsevier; 2008. p. 203–6.CrossRefGoogle Scholar
  41. 41.
    Greer LT, Kuehn RB, Gillespie DL, White PW, Bell RS, Armonda RA, Fox CJ. Contemporary management of combat-related vertebral artery injuries. J Trauma Acute Care Surg. 2013;74(3):818–24.CrossRefGoogle Scholar
  42. 42.
    Lee TS, Ducic Y, Gordin E, Stroman D. Management of carotid artery trauma. Craniomaxillofac Trauma Reconstr. 2014;7:175–89.CrossRefGoogle Scholar
  43. 43.
    Pham MH, Rahme RJ, Arnaout O, et al. Endovascular stenting of extracranial carotid and vertebral artery dissections: a systematic review of the literature. Neurosurgery. 2011;68:856–66.CrossRefGoogle Scholar
  44. 44.
    Yamada R, Miller C, Guimaraes M, Schnōltz C. Overview of endovascular management of traumatic carotid lesions. Determining appropriate intervention based on lesion severity and patient characteristics. Endov Today. 2016;15(1):79–82.Google Scholar
  45. 45.
    Dolati P, Eichberg D, Thomas A, Ogilvy C. Aneurysms of the external carotid artery and its branch vessels: a case report, pooled data analysis, and current treatment strategies. J Neurosurg Sci. 2015. [published online ahead of print September 25, 2015].Google Scholar
  46. 46.
    Buchanan LS. Neck. In: The shock trauma manual of operative techniques. New York: Springer; 2015. p. 3–12.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Stefano Pirrelli
    • 1
    Email author
  • Pietro Quaretti
    • 2
  • Lorenzo Moramarco
    • 2
  • Vittorio Arici
    • 3
  • Antonio Bozzani
    • 3
  • Riccardo Corti
    • 2
  1. 1.Chief Unit of Vascular Surgery, Cardiothoracovascular DepartmentAsst Mantova, Ospedale Carlo PomaMantovaItaly
  2. 2.Interventional Radiology UnitFoundation IRCCS Policlinico San MatteoPaviaItaly
  3. 3.Vascular Surgery UnitFoundation IRCCS Policlinico San MatteoPaviaItaly

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