Stab wound with transection of left vertebral artery at V3

While vertebral artery injuries are uncommon, they can have significant morbidity if not identified and treated in a timely fashion. While the majority of vertebral artery injuries are the result of blunt injury and typically have favorable outcomes, a substantial percentage of patients with penetrating injury to the neck may also have vertebral artery injury necessitating angiographic or operative intervention. A 45-year-old male sustained a single stab wound to the apex of the posterior triangle of the neck, below the left mastoid process. At the scene, Emergency Medical Services personnel reported large blood loss and upon arrival, his initial vital signs were consistent with Class II/III hemorrhagic shock. Physical examination revealed a 9 cm longitudinal and deep laceration which began to bleed rapidly and profusely during his inital evaluation. The patient was intubated and rapidly transported to the operating room for exploration of the wound with direct control of the suspected vascular injury via suture ligation and application of vascular clips and to interventional radiology suite for embolization. Operative control was necessary however, immediate post-operative angiography allowed confirmation of collateral cerebral perfusion. The patient had an uneventful recovery and was evaluated in the Trauma Clinic during his 7, 14, 30 and 60-day follow-up.