Vascular Injuries of the Neck

The incidence of traumatic injuries in civil practice ranges from 3.5 to 8.2% of total arterial lesions, being in detail the following: for 0.2% for single vessels, 3% for brachiocephalic lesions, 3–4.5% for subclavian artery, 5.2–8.2% for carotid artery, and 0.7–1% for vertebral artery. Under an etiologic point of view, the traumatic injuries are often localized to the front of the neck and the upper chest, mainly due to penetrating lesions (80% of cases), contusions (3–10% of cases), and iatrogenic (10% of cases) with differences depending on the vessel affected by the trauma. The diagnosis is mainly based on the analysis of trauma mechanism, the presence of skin lesions, and the CT scan results. Often they are associated with other scheletric lesions and visceral lesions which can minimize the effect of vessel trauma, especially in blunt injuries. The endovascular approach is the treatment of choice, with particular attention to the endovascular control of bleeding and treatment also if the “open” surgical treatment may be beneficial especially in carotid injuries.