ABSTRACT
Injury to major vascular structures of the head and neck complicates 25 per cent of cervical injuries. Carotid artery (CA) injuries constitute 5-10 per cent of all arterial injuries, while injuries to the vertebral artery (VA), once thought to be uncommon, account for 30 per cent of all cervical vascular injuries.1 Penetrating trauma is the leading cause of cervical vascular injury, with less than 10 per cent of injuries following blunt trauma.2 Despite significant advances in the diagnosis and management of these injuries, mortality remains at 10-30 per cent, and the incidence of permanent neurological deficit approximates 40 per cent.3-5
Ambroise Paré successfully treated a CA injury by ligation in 1522.6 Ligation, which resulted in high rates of hemiplegia and death, remained the only mode of management until the twentieth century. The application of techniques of primary arterial repair, first employed during the Korean conflict, to civilian carotid injuries, resulted in significant reductions in neurological injury and mortality. However, following a report by Wylie et al.7 of intracranial haemorrhage after carotid revascularisation for acute thrombotic stroke, Cohen questioned the wisdom of carotid repair in the neurologically compromised patient.8
