gms | German Medical Science

Objective: The published overall incidence of blunt artery injuries (BCVI) among trauma patients varies between 0.1% and 2.7% depending on the screening modalities. This incidence of reported BCVIs rises up to 48% in patients with isolated cervical spine injuries. The aim of this analysis is to determine the incidence of initially diagnosed craniocervical artery injuries in cervical and craniocervical trauma patients and to define screening triggers for BCVIs.

Method: Cohort analysis of a total of 717 patients with traumatic cervical and craniocervical lesions, treated 1/2003-12/2014 in a level 1 trauma center.

Results: Incidence of initially diagnosed and treatment decision relevant BCVIs in cervical and craniocervical trauma patients was 3,1%-4,8%. In the majority diagnosis was made by whole body CT-scanning, including CT-angiography, followed by MRA, DSA, and duplex ultrasonography. ICA was involved in 8, and VA in 14 cases. More specifically, arterial dissection accounted for 94.1% of the vessel injuries. 1 case with a traumatic pseudoaneurysm was detected. In 9 cases of vascular lesions, high-grade stenosis or even complete vessel occlusion were found already at the time of admission, resulting in cerebral ischemia in 7 cases. Predictive factors for BCVIs in cervical trauma patients were found to be transverse foramen involvement, sub-/luxation injuries, combined head and isolated midface injuries, and ligamentous injuries in pediatric patients.

Conclusions: Whole body CT scanning of trauma patients with adapted CT angiography protocols has led to a higher detection rate of BCVIs and should therefore be mandatory. Since untreated vascular injuries have a reported stroke risk of more than 20%, early diagnosis in a screening like fashion and immediate therapeutic considerations, may help to lower this risk.