A NEW APPROACH TO THE TREATMENT OF PENETRATING INJURIES TO THE VERTEBRAL ARTERY - A CASE-REPORT

Penetrating injuries to the vertebral artery remain an unusual, yet ch allenging, problem in trauma patients. Once thought to be rare, the aw areness of this type of injury is increasing, in part because of arter iography for patients with penetrating cervical trauma. Mortality rate s have been reported from 5-50% in various reviews. Early and late com plications are common and often life-threatening. These include bleedi ng, pseudoaneurysm, arteriovenous fistula, thrombosis, and stroke. In addition, distal vertebral artery trauma represents a distinctly more complex and technically challenging problem. Standard surgical practic e has been operative ligation (proximal and distal) and/or direct repa ir of the injured vessel. However, surgical exposure and repair of the injured vessel is often technically difficult, especially when the up per cervical portion of the artery is involved. Interventional radiolo gic techniques are now being used to diagnose and treat many complex v ascular injuries. A new treatment for a Zone III vertebral artery guns hot wound is presented here. Using endovascular techniques the authors were able to successfully occlude the proximal vertebral artery via a n ipsilateral approach, and the distal vertebral artery via a contrala teral approach. This unique application of nonoperative interventional technique has significant implications for vascular surgery. This rep ort represents the first successful treatment of a Zone III vertebral artery occlusion treated by endovascular methods.