Vertebral artery injury in major trauma patients in Saudi Arabia: A retrospective cohort study

Abstract

Blunt vertebral artery injury (VAI) is associated with severe cervicocephalic trauma and may have devastating consequences. This study aimed to determine the incidence and nature of VAI in polytrauma patients. The secondary objective was to assess the association of VAI with previously suggested risk factors. It was a retrospective observational study of all polytrauma patients admitted to the trauma unit between April 2018 and July 2019, who had CT neck angiography to diagnose blunt VAI according to modified Denver criteria. Out of 1084 admitted polytrauma patients, 1025 (94.6%) sustained blunt trauma. Of these, 120 (11.7%) underwent screening CT neck angiography. VAI was detected in 10 (8.3%; 95% CI 4.1–14.8) patients. There were three patients with Grade I injury, two with Grade II, and five with Grade IV injury. Among all trauma admissions, the incidence of diagnosed VAI was 0.9% (95% CI 0.5–1.8). Among patients suspected of VAI, there was no univariable association of VAI with C-Spine fracture: OR 4.2 (95% CI 0.51–34.4; p = 0.18). There were two (20%) deaths related to VAI. Traumatic VAI was uncommonly detected in this major trauma service in Saudi Arabia. High suspicion and liberal screening by CT angiography in cases where VAI is possible should be considered to avoid missed injuries.

Prognostic factors for femoropopliteal vascular injuries: surgical decisions matter

“…[37][38][39] If it is not possible to the correct techniques because of hemodynamic instability, lack of necessary materials, or other reasons, it is recommended that "damage control" strategies capable of having a positive impact on prognosis of the traumatized limb should be employed. 2,3,10,17,25 The fact that 37.2% of the patients were admitted in hypovolemic shock contrasts with the sporadic description of damage control techniques in this sample, such as a temporary vascular shunt, a tool surgeons who deal with these traumas should master. 2,3,9,11,17,25 All of the cases analyzed in this study were operated by vascular surgeons.…”

“…When this association was not detected, the reintervention rate was 29.1%, but when it was present the rate was 93.3% (Table 5), equating to a 34.1 times increase in the probability of surgical reintervention (Figure 2). The most frequent reinterventions were debridement (10) and fasciotomy or extension of prior fasciotomy (8), followed by venous graft (5), thrombectomy (4), arterial venous ligation (1), and pseudoaneurysm repair(1). Although reinterventions were more frequent when arterial and venous injuries were both present, there were no statistically significant differences in the common femoral vessels, superficial femoral vessels, or popliteal vessels (p = 0.4069; p = 0.1681; and p = 0.2593, respectively).…”

“…The frequency of these traumatisms has been growing and it is estimated that around 6% of civilian traumas involve vascular injury, 2 while they occur in up to 17.6% of military traumas. [2][3][4][8][9][10][11][12] Involvement of limb vessels is common and is associated with risk of death and amputation. 4,5 Many different factors influence development of unfavorable clinical outcomes in cases of vascular traumatisms involving the limbs.…”

A Systematic Review and Meta-Analysis of Vertebral Artery Injury After Cervical Spine Trauma

“…The most utilised management strategy was combined anticoagulation and antiplatelet therapy (25.5%, n = 121/475). 16.4% (n = 78/475) were managed with just antiplatelet, 14.1% (n = 67/475) with anticoagulation, and 17.8% (n = 85/475) managed with conservative/expectant management. Other management options (n = 124/475) included a variety of surgical methods, stents, embolisation and endovascular techniques and the reason for the variation could not be delineated.…”

Fatores prognósticos em traumatismos vasculares do segmento femoropoplíteo: decisões intraoperatórias são importantes

“…Embora acometa principalmente homens jovens [1][2][3][4][5][6][7][8] , pacientes de todas as idades e gêneros podem sofrer lesões vasculares traumáticas. A frequência desses traumatismos tem sido crescente, estimando-se que cerca de 6% dos traumatizados civis apresentem lesão vascular 2 , sendo que em militares essas lesões representem até 17,6% dos traumas [2][3][4][8][9][10][11][12] .…”