Contemporary management of combat-related  vertebral artery injuries. 

 -  2013 
<br/><br/>Available online from MWHC library: 1995 -  present, Available in print through MWHC library: 1999 -  2006 
<br/><br/> BACKGROUND: Vertebral artery injuries (VAIs)  following cervical trauma are uncommon. Advances in imaging  technology and emerging endovascular therapies have allowed  for the improved diagnosis and treatment of VAIs. We aimed  to examine the contemporary management of combat-related  penetrating VAIs during current US military operations.  CONCLUSION: VAIs are infrequent in modern combat  operations, occurring in only 3% of casualties experiencing  arterial injuries and are often incidentally discovered  during the delayed secondary evaluation of penetrating face  and neck injuries at higher echelons of care. One should  have a high index of suspicious for a VAI in a casualty with  concurrent cervical spine fractures. Endovascular therapies  using coils and covered stents have expanded the management  options and simplified the treatment of combat-related VAIs.  LEVEL OF EVIDENCE: Therapeutic study, level V.  METHODS: A retrospective review was performed on  US casualties with combat-related VAIs evacuated to a single  military institution in the US from September 2001 to 2010  for definitive management. Casualty demographics, mechanism  of injury, location and type of VAI, neurologic sequela,  associated injuries, method of diagnosis, and therapeutic  management were collected.  RESULTS: Eleven casualties with a mean age of 26  years (mean [SD] ISS, 18 [7.0]) were found to have VAIs from  gunshot wounds (6, 55%) or blast fragments (5, 45%).  Cervical spine fractures (8, 72%), facial fractures (5,  45%), and spinal cord injury (3, 27%) were not uncommon. One  casualty experienced a posterior cerebellar and parietal  infarcts. All injuries were evaluated with digital  subtraction angiography, 64-slice multidetector row computed  tomography, or both. Casualties were noted to have vertebral  artery occlusion (4, 36%), pseudoaneurysms (5, 45%),  dissection (1, 9%), or arteriovenous fistula (1, 9%), with  most injuries occurring in the V2 segment (6, 55%).  Pseudoaneurysms were treated with coiling or stent-assisted  coiling. Of 11 casualties, 6 were managed nonoperatively,  half of whom with anticoagulation or antiplatelet therapy. 
<br/><br/><br/>English 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Diagnostic Imaging/mt [Methods]<br/>*Endovascular Procedures/td [Trends]<br/>*Military Personnel<br/>*Neck Injuries/su [Surgery]<br/>*Vascular System Injuries/su [Surgery]<br/>*Vertebral Artery/in [Injuries]<br/>Adult<br/>Afghan Campaign 2001-<br/>Follow-Up Studies<br/>Humans<br/>Incidence<br/>Male<br/>Neck Injuries/ep [Epidemiology]<br/>Neck Injuries/ra [Radiography]<br/>Retrospective Studies<br/>Treatment Outcome<br/>United States/ep [Epidemiology]<br/>Vascular System Injuries/ep [Epidemiology]<br/>Vascular System Injuries/ra [Radiography]<br/>Vertebral Artery/ra [Radiography]<br/>Vertebral Artery/su [Surgery]<br/>Young Adult
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Washington Hospital Center
<br/><br/><label>Index Terms--Occupation: </label><br/>Radiology
<br/><br/><label>Index Terms--Function: </label><br/>Comparative Study<br/>Journal Article<br/>Research Support, Non-U.S. Gov't