Traumatic vascular injuries and their management

Neurovascular trauma can result in injury to the extracranial and intracranial carotid and vertebral as well as their intracranial cerebral branches. The types of injuries encountered include intimal tears, flaps, occlusions, dissections, pseudoaneurysms, and arteriovenous fistulae. Most traumatic injuries are probably underdiagnosed. The majority of the extracranial injuries recover with conservative medical therapy, however pseudoaneurysms and AV fistulae are unlikely to resolve on their own and are like to result in significant morbidity if left untreated. Direct surgical repair has been performed in the past, but more recently, endovascular techniques have offered less invasive alternatives.