Mwipatayi B P, Jeffery P, Beningfield S J, Motale P, Tunnicliffe J, Navsaria P H
Department of Surgery, Vascular Unit, Groote Schur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa.
Eur J Vasc Endovasc Surg. 2004 Feb;27(2):157-62. doi: 10.1016/j.ejvs.2003.11.008.
To review the management of vertebral artery injuries, and the impact of pre-operative angiography.
A retrospective review was conducted of all patients with vertebral artery (VA) injuries admitted to Groote Schuur Hospital, Cape Town between January 1987 and December 2002. Patients presenting with uncontrolled active bleeding or haemodynamic instability with a poor response to resuscitation were taken immediately to surgery. Stable patients, including those who stabilised after simple resuscitation, with evidence of a vascular injury (a bruit or a large haematoma) or trans-cervical gunshot wounds, underwent routine aortic arch and selective angiography.
One hundred and one patients with vertebral artery injuries were included in the study. Ninety-two patients sustained penetrating injuries (41 gunshot, 51 stab), three were iatrogenic and six due to blunt trauma. Angiography was performed as the primary investigation in 88 patients, while seven patients had angiography following surgery. Thirty-nine vertebral artery occlusions, 11 arteriovenous fistulae, two intimal injuries and 36 false aneurysms were identified. Thirty-three radiological interventions were performed. There were 22 associated vascular injuries in 16 patients, 27 nerve injuries in 25 patients, 11 osseous injuries in nine patients and eight aerodigestive injuries. Seven patients died.
Angiography and intervention is of great benefit in the diagnosis and management of traumatic vertebral artery injuries. Angiography often avoids unnecessary exploration and permits endovascular treatment.
回顾椎动脉损伤的处理方法以及术前血管造影的影响。
对1987年1月至2002年12月间入住开普敦格罗特舒尔医院的所有椎动脉（VA）损伤患者进行回顾性研究。出现无法控制的活动性出血或血流动力学不稳定且复苏效果不佳的患者立即接受手术。病情稳定的患者，包括经简单复苏后病情稳定、有血管损伤证据（血管杂音或大血肿）或经颈部枪伤的患者，接受常规主动脉弓和选择性血管造影。
101例椎动脉损伤患者纳入研究。92例为穿透伤（41例枪伤，51例刺伤），3例为医源性损伤，6例为钝性创伤。88例患者将血管造影作为主要检查手段，7例患者在手术后进行血管造影。共发现39例椎动脉闭塞、11例动静脉瘘、2例内膜损伤和36例假性动脉瘤。进行了33次放射介入治疗。16例患者伴有22处血管损伤，25例患者伴有27处神经损伤，9例患者伴有11处骨损伤，8例患者伴有气消化道损伤。7例患者死亡。
血管造影及介入治疗在创伤性椎动脉损伤的诊断和处理中具有重要价值。血管造影常可避免不必要的探查，并允许进行血管内治疗。
