A systematic review of penetrating extracranial vertebral artery injuries

Juan A. Asensio, Parinaz J. Dabestani, Florian A. Wenzl, Stephanie S. Miljkovic, John J. Kessler, Carlos A. Fernandez, Tyson Becker, David Cornell, Margaret Siu, Charles Voigt, Devendra K. Agrawal

Research output: Contribution to journalReview article

Abstract

Background: Penetrating vertebral artery injuries (VAIs) are rare. Because of their rarity, complex anatomy, and difficult surgical exposures, few surgeons and trauma centers have developed significant experience with their management. The objectives of this study were to review their incidence, clinical presentation, radiologic identification, management, complications, and outcomes and to provide a review of anatomic exposures and surgical techniques for their management. Methods: A literature search on MEDLINE Complete-PubMed, Cochrane, Ovid, and Embase for the period of 1893 to 2018 was conducted. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. Our literature search yielded a total of 181 potentially eligible articles with 71 confirmed articles, consisting of 21 penetrating neck injury series, 13 VAI-specific series, and 37 case reports. Operative procedures and outcomes were recorded along with methods of angiographic imaging and operative management. All articles were reviewed by at least two independent authors, and data were analyzed collectively. Results: There were a total of 462 patients with penetrating VAIs. The incidence of VAI in the civilian population was 3.1% vs 0.3% in the military population. More complete data were available from 13 collected VAI-specific series and 37 case reports for a total of 362 patients. Mechanism of injury data were available for 341 patients (94.2%). There were gunshot wounds (178 patients [49.2%]), stab wounds (131 [73.6%]), and miscellaneous mechanisms of injury (32 [8.8%]). Anatomic site of injury data were available for 177 (49%) patients: 92 (25.4%) left, 84 (23.2%) right, and 1 (0.3%) bilateral. Anatomic segment of injury data were available for 204 patients (56.4%): 28 (7.7%) V1, 125 (34.5%) V2, and 51 (14.1%) V3. Treatment data were available for 212 patients. Computed tomography angiography was the most common imaging modality (163 patients [77%]). Injuries were addressed by operative management (94 [44.3%]), angiography and angioembolization (72 [34%]), combined approaches (11 [5.2%]), and observation (58 [27.4%]). Stenting and repair were less frequently employed (10 [4.7%]). The incidence of aneurysms or pseudoaneurysms was 18.5% (67); the incidence of arteriovenous fistula was 16.9% (61). The calculated mortality in VAI-specific series was 15.1%; in the individual case report group, it was 10.5%. Conclusions: The majority of VAIs present without neurologic symptoms, although some may present with exsanguinating hemorrhage. Computed tomography angiography should be considered first line to establish diagnosis. Gunshot wounds account for most injuries. The most frequently injured segment is V2. Surgical ligation is the most common intervention, followed by angioembolization, both of which constitute important management approaches.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
DOIs
StateAccepted/In press - Jan 1 2020

Fingerprint

Vertebral Artery
Wounds and Injuries
Gunshot Wounds
Incidence
Exsanguination
Neck Injuries
Stab Wounds
Trauma Centers
False Aneurysm
Arteriovenous Fistula
Operative Surgical Procedures
Neurologic Manifestations
PubMed
MEDLINE
Population
Aneurysm
Ligation
Meta-Analysis
Anatomy
Angiography

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

A systematic review of penetrating extracranial vertebral artery injuries. / Asensio, Juan A.; Dabestani, Parinaz J.; Wenzl, Florian A.; Miljkovic, Stephanie S.; Kessler, John J.; Fernandez, Carlos A.; Becker, Tyson; Cornell, David; Siu, Margaret; Voigt, Charles; Agrawal, Devendra K.

In: Journal of Vascular Surgery, 01.01.2020.

Research output: Contribution to journalReview article

Asensio, JA, Dabestani, PJ, Wenzl, FA, Miljkovic, SS, Kessler, JJ, Fernandez, CA, Becker, T, Cornell, D, Siu, M, Voigt, C & Agrawal, DK 2020, 'A systematic review of penetrating extracranial vertebral artery injuries', Journal of Vascular Surgery. https://doi.org/10.1016/j.jvs.2019.10.084
Asensio, Juan A. ; Dabestani, Parinaz J. ; Wenzl, Florian A. ; Miljkovic, Stephanie S. ; Kessler, John J. ; Fernandez, Carlos A. ; Becker, Tyson ; Cornell, David ; Siu, Margaret ; Voigt, Charles ; Agrawal, Devendra K. / A systematic review of penetrating extracranial vertebral artery injuries. In: Journal of Vascular Surgery. 2020.
@article{82e4b0bfe82f4915a5ed750149f6fadf,
title = "A systematic review of penetrating extracranial vertebral artery injuries",
abstract = "Background: Penetrating vertebral artery injuries (VAIs) are rare. Because of their rarity, complex anatomy, and difficult surgical exposures, few surgeons and trauma centers have developed significant experience with their management. The objectives of this study were to review their incidence, clinical presentation, radiologic identification, management, complications, and outcomes and to provide a review of anatomic exposures and surgical techniques for their management. Methods: A literature search on MEDLINE Complete-PubMed, Cochrane, Ovid, and Embase for the period of 1893 to 2018 was conducted. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. Our literature search yielded a total of 181 potentially eligible articles with 71 confirmed articles, consisting of 21 penetrating neck injury series, 13 VAI-specific series, and 37 case reports. Operative procedures and outcomes were recorded along with methods of angiographic imaging and operative management. All articles were reviewed by at least two independent authors, and data were analyzed collectively. Results: There were a total of 462 patients with penetrating VAIs. The incidence of VAI in the civilian population was 3.1{\%} vs 0.3{\%} in the military population. More complete data were available from 13 collected VAI-specific series and 37 case reports for a total of 362 patients. Mechanism of injury data were available for 341 patients (94.2{\%}). There were gunshot wounds (178 patients [49.2{\%}]), stab wounds (131 [73.6{\%}]), and miscellaneous mechanisms of injury (32 [8.8{\%}]). Anatomic site of injury data were available for 177 (49{\%}) patients: 92 (25.4{\%}) left, 84 (23.2{\%}) right, and 1 (0.3{\%}) bilateral. Anatomic segment of injury data were available for 204 patients (56.4{\%}): 28 (7.7{\%}) V1, 125 (34.5{\%}) V2, and 51 (14.1{\%}) V3. Treatment data were available for 212 patients. Computed tomography angiography was the most common imaging modality (163 patients [77{\%}]). Injuries were addressed by operative management (94 [44.3{\%}]), angiography and angioembolization (72 [34{\%}]), combined approaches (11 [5.2{\%}]), and observation (58 [27.4{\%}]). Stenting and repair were less frequently employed (10 [4.7{\%}]). The incidence of aneurysms or pseudoaneurysms was 18.5{\%} (67); the incidence of arteriovenous fistula was 16.9{\%} (61). The calculated mortality in VAI-specific series was 15.1{\%}; in the individual case report group, it was 10.5{\%}. Conclusions: The majority of VAIs present without neurologic symptoms, although some may present with exsanguinating hemorrhage. Computed tomography angiography should be considered first line to establish diagnosis. Gunshot wounds account for most injuries. The most frequently injured segment is V2. Surgical ligation is the most common intervention, followed by angioembolization, both of which constitute important management approaches.",
author = "Asensio, {Juan A.} and Dabestani, {Parinaz J.} and Wenzl, {Florian A.} and Miljkovic, {Stephanie S.} and Kessler, {John J.} and Fernandez, {Carlos A.} and Tyson Becker and David Cornell and Margaret Siu and Charles Voigt and Agrawal, {Devendra K.}",
year = "2020",
month = "1",
day = "1",
doi = "10.1016/j.jvs.2019.10.084",
language = "English (US)",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - A systematic review of penetrating extracranial vertebral artery injuries

AU - Asensio, Juan A.

AU - Dabestani, Parinaz J.

AU - Wenzl, Florian A.

AU - Miljkovic, Stephanie S.

AU - Kessler, John J.

AU - Fernandez, Carlos A.

AU - Becker, Tyson

AU - Cornell, David

AU - Siu, Margaret

AU - Voigt, Charles

AU - Agrawal, Devendra K.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Background: Penetrating vertebral artery injuries (VAIs) are rare. Because of their rarity, complex anatomy, and difficult surgical exposures, few surgeons and trauma centers have developed significant experience with their management. The objectives of this study were to review their incidence, clinical presentation, radiologic identification, management, complications, and outcomes and to provide a review of anatomic exposures and surgical techniques for their management. Methods: A literature search on MEDLINE Complete-PubMed, Cochrane, Ovid, and Embase for the period of 1893 to 2018 was conducted. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. Our literature search yielded a total of 181 potentially eligible articles with 71 confirmed articles, consisting of 21 penetrating neck injury series, 13 VAI-specific series, and 37 case reports. Operative procedures and outcomes were recorded along with methods of angiographic imaging and operative management. All articles were reviewed by at least two independent authors, and data were analyzed collectively. Results: There were a total of 462 patients with penetrating VAIs. The incidence of VAI in the civilian population was 3.1% vs 0.3% in the military population. More complete data were available from 13 collected VAI-specific series and 37 case reports for a total of 362 patients. Mechanism of injury data were available for 341 patients (94.2%). There were gunshot wounds (178 patients [49.2%]), stab wounds (131 [73.6%]), and miscellaneous mechanisms of injury (32 [8.8%]). Anatomic site of injury data were available for 177 (49%) patients: 92 (25.4%) left, 84 (23.2%) right, and 1 (0.3%) bilateral. Anatomic segment of injury data were available for 204 patients (56.4%): 28 (7.7%) V1, 125 (34.5%) V2, and 51 (14.1%) V3. Treatment data were available for 212 patients. Computed tomography angiography was the most common imaging modality (163 patients [77%]). Injuries were addressed by operative management (94 [44.3%]), angiography and angioembolization (72 [34%]), combined approaches (11 [5.2%]), and observation (58 [27.4%]). Stenting and repair were less frequently employed (10 [4.7%]). The incidence of aneurysms or pseudoaneurysms was 18.5% (67); the incidence of arteriovenous fistula was 16.9% (61). The calculated mortality in VAI-specific series was 15.1%; in the individual case report group, it was 10.5%. Conclusions: The majority of VAIs present without neurologic symptoms, although some may present with exsanguinating hemorrhage. Computed tomography angiography should be considered first line to establish diagnosis. Gunshot wounds account for most injuries. The most frequently injured segment is V2. Surgical ligation is the most common intervention, followed by angioembolization, both of which constitute important management approaches.

AB - Background: Penetrating vertebral artery injuries (VAIs) are rare. Because of their rarity, complex anatomy, and difficult surgical exposures, few surgeons and trauma centers have developed significant experience with their management. The objectives of this study were to review their incidence, clinical presentation, radiologic identification, management, complications, and outcomes and to provide a review of anatomic exposures and surgical techniques for their management. Methods: A literature search on MEDLINE Complete-PubMed, Cochrane, Ovid, and Embase for the period of 1893 to 2018 was conducted. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. Our literature search yielded a total of 181 potentially eligible articles with 71 confirmed articles, consisting of 21 penetrating neck injury series, 13 VAI-specific series, and 37 case reports. Operative procedures and outcomes were recorded along with methods of angiographic imaging and operative management. All articles were reviewed by at least two independent authors, and data were analyzed collectively. Results: There were a total of 462 patients with penetrating VAIs. The incidence of VAI in the civilian population was 3.1% vs 0.3% in the military population. More complete data were available from 13 collected VAI-specific series and 37 case reports for a total of 362 patients. Mechanism of injury data were available for 341 patients (94.2%). There were gunshot wounds (178 patients [49.2%]), stab wounds (131 [73.6%]), and miscellaneous mechanisms of injury (32 [8.8%]). Anatomic site of injury data were available for 177 (49%) patients: 92 (25.4%) left, 84 (23.2%) right, and 1 (0.3%) bilateral. Anatomic segment of injury data were available for 204 patients (56.4%): 28 (7.7%) V1, 125 (34.5%) V2, and 51 (14.1%) V3. Treatment data were available for 212 patients. Computed tomography angiography was the most common imaging modality (163 patients [77%]). Injuries were addressed by operative management (94 [44.3%]), angiography and angioembolization (72 [34%]), combined approaches (11 [5.2%]), and observation (58 [27.4%]). Stenting and repair were less frequently employed (10 [4.7%]). The incidence of aneurysms or pseudoaneurysms was 18.5% (67); the incidence of arteriovenous fistula was 16.9% (61). The calculated mortality in VAI-specific series was 15.1%; in the individual case report group, it was 10.5%. Conclusions: The majority of VAIs present without neurologic symptoms, although some may present with exsanguinating hemorrhage. Computed tomography angiography should be considered first line to establish diagnosis. Gunshot wounds account for most injuries. The most frequently injured segment is V2. Surgical ligation is the most common intervention, followed by angioembolization, both of which constitute important management approaches.

UR - http://www.scopus.com/inward/record.url?scp=85077399566&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85077399566&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2019.10.084

DO - 10.1016/j.jvs.2019.10.084

M3 - Review article

AN - SCOPUS:85077399566

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

ER -