{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T09:46:49Z","timestamp":1771235209311,"version":"3.50.1"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","license":[{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Modern combat\u2013related vertebral artery (VA) injuries are increasingly being diagnosed, but the management of such injuries remains controversial. The authors report the frequency and characteristics of combat-related penetrating VA injuries and the indications for endovascular treatment, as well as analyze their treatment outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A 1-year prospective study was completed at a civilian medical center in Dnipro, Ukraine, in all patients with VA injuries sustained during the Russian invasion in the 1st year of war. The authors evaluated the location, type, and severity of the VA injuries and concomitant injuries, as well as the type of intervention and outcomes at 1 month.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>In total, 279 wounded patients underwent cerebral angiography and 30 (10.8%) patients had VA injuries. All patients were male. There were 28 soldiers and 2 civilians with a mean age of 37.5 years. Four (13.3%) patients had Bissl grade I injuries, 4 (13.3%) had grade II injuries, 4 (13.3%) had grade III injuries (pseudoaneurysm), and 18 (60.0%) had grade IV injuries (occlusion). Four (13.3%) patients underwent emergency open surgical intervention. Fourteen (46.7%) patients underwent endovascular intervention. There was a significant relationship between the anatomical level of the VA injury and surgical intervention (p &lt; 0.05). Endovascular intervention was correlated with the severity of vascular injury to the VA, with 12.5% of the patients receiving intervention for grade I and II lesions and 59.1% receiving intervention for grade III and IV lesions (p &lt; 0.05). The overall mortality in the study group was 6.7% (n = 2), and both died of ischemic complications.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>In modern armed conflicts, VA injuries are much more common than reported for previous wars. With the available modern endovascular technology, cerebral angiography is warranted for suspected VA injury and allows for both the diagnosis and treatment of these injuries. Whether endovascular intervention is performed depends on the level and severity of VA injury, severity of concomitant injuries, and presence of collateral circulation.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.12.jns232316","type":"journal-article","created":{"date-parts":[[2024,2,24]],"date-time":"2024-02-24T02:10:22Z","timestamp":1708740622000},"page":"445-454","source":"Crossref","is-referenced-by-count":3,"title":["Incidence and management of traumatic vertebral artery injuries: wartime experience in Ukraine"],"prefix":"10.3171","volume":"141","author":[{"given":"Andrii","family":"Sirko","sequence":"first","affiliation":[{"name":"Center for \u0421erebral Neurosurgery, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yurii","family":"Cherednychenko","sequence":"additional","affiliation":[{"name":"Endovascular \u0421enter, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ehsan","family":"Dowlati","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC; and"},{"name":"Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vadym","family":"Perepelytsia","sequence":"additional","affiliation":[{"name":"Endovascular \u0421enter, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rocco A.","family":"Armonda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Eur J Vasc Endovasc Surg","first-page":"157","article-title":"Management of extra-cranial vertebral artery injuries","volume":"27","author":"Mwipatayi BP","year":"2004","unstructured":"Mwipatayi BP, Jeffery P, Beningfield SJ, Motale P, Tunnicliffe J, Navsaria PH. Management of extra-cranial vertebral artery injuries. Eur J Vasc Endovasc Surg. 2004;27(2):157\u2013162."},{"issue":"3","key":"b2","series-title":"J Trauma","first-page":"480","article-title":"Extraluminal, transluminal, and observational treatment for vertebral artery injuries","volume":"39","author":"Yee LF","year":"1995","unstructured":"Yee LF, Olcott EW, Knudson MM, Lim RC Jr. Extraluminal, transluminal, and observational treatment for vertebral artery injuries. J Trauma. 1995;39(3):480\u2013486."},{"issue":"7","key":"b3","series-title":"J Trauma","first-page":"1007","article-title":"Forty-three cases of vertebral artery trauma","volume":"28","author":"Reid JD","year":"1988","unstructured":"Reid JD, Weigelt JA. Forty-three cases of vertebral artery trauma. J Trauma. 1988;28(7):1007\u20131012."},{"key":"b4","series-title":"Acute Care Neurosurgery by Case Management: Pearls and Pitfalls","first-page":"71","article-title":"Traumatic arterial and venous injuries","author":"Miller CA","year":"2022","unstructured":"Miller CA, Dowlati E, Armonda R. Traumatic arterial and venous injuries. In: Raksin PB, ed. Acute Care Neurosurgery by Case Management: Pearls and Pitfalls. Springer International Publishing; 2022:71-81."},{"issue":"6","key":"b5","series-title":"J Vasc Surg","first-page":"2161","article-title":"A systematic review of penetrating extracranial vertebral artery injuries","volume":"71","author":"Asensio JA","year":"2020","unstructured":"Asensio JA, Dabestani PJ, Wenzl FA,  A systematic review of penetrating extracranial vertebral artery injuries. J Vasc Surg. 2020;71(6):2161\u20132169."},{"issue":"1","key":"b6","series-title":"Eur J Trauma Emerg Surg","first-page":"481","article-title":"Penetrating injuries to the vertebral artery: interventions and outcomes from US Trauma Centers","volume":"48","author":"Schellenberg M","year":"2022","unstructured":"Schellenberg M, Owattanapanich N, Cowan S,  Penetrating injuries to the vertebral artery: interventions and outcomes from US Trauma Centers. Eur J Trauma Emerg Surg. 2022;48(1):481\u2013488."},{"issue":"2764","key":"b7","series-title":"BMJ","first-page":"1569","article-title":"The Bradshaw Lecture on Gunshot Injuries of the Arteries","volume":"2","author":"Makins GH","year":"1913","unstructured":"Makins GH. The Bradshaw Lecture on Gunshot Injuries of the Arteries. BMJ. 1913;2(2764):1569\u20131577."},{"issue":"4","key":"b8","series-title":"Ann Surg","first-page":"534","article-title":"Battle injuries of the arteries in World War II. An analysis of 2,471 cases","volume":"123","author":"Debakey ME","year":"1946","unstructured":"Debakey ME, Simeone FA. Battle injuries of the arteries in World War II. An analysis of 2,471 cases. Ann Surg. 1946;123(4):534\u2013579."},{"issue":"4","key":"b9","series-title":"Ann Surg","first-page":"555","article-title":"Arterial repair during the Korean war","volume":"147","author":"Hughes CW","year":"1958","unstructured":"Hughes CW. Arterial repair during the Korean war. Ann Surg. 1958;147(4):555\u2013561."},{"issue":"6","key":"b10","series-title":"Surgery","first-page":"817","article-title":"Traumatic arteriovenous fistulas and false aneurysms: a review of 558 lesions","volume":"78","author":"Rich NM","year":"1975","unstructured":"Rich NM, Hobson RW II, Collins GJ Jr. Traumatic arteriovenous fistulas and false aneurysms: a review of 558 lesions. Surgery. 1975;78(6):817\u2013828."},{"issue":"3","key":"b11","series-title":"J Trauma Acute Care Surg","first-page":"818","article-title":"Contemporary management of combat-related vertebral artery injuries","volume":"74","author":"Greer LT","year":"2013","unstructured":"Greer LT, Kuehn RB, Gillespie DL,  Contemporary management of combat-related vertebral artery injuries. J Trauma Acute Care Surg. 2013;74(3):818\u2013824."},{"issue":"6","key":"b12","series-title":"Ann Surg","first-page":"1184","article-title":"The epidemiology of vascular injury in the wars in Iraq and Afghanistan","volume":"253","author":"White JM","year":"2011","unstructured":"White JM, Stannard A, Burkhardt GE, Eastridge BJ, Blackbourne LH, Rasmussen TE. The epidemiology of vascular injury in the wars in Iraq and Afghanistan. Ann Surg. 2011;253(6):1184\u20131189."},{"issue":"5","key":"b13","series-title":"Ann Surg","first-page":"699","article-title":"Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography","volume":"235","author":"Biffl WL","year":"2002","unstructured":"Biffl WL, Ray CE Jr, Moore EE,  Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography. Ann Surg. 2002;235(5):699\u2013707."},{"issue":"5","key":"b14","series-title":"J Trauma","first-page":"845","article-title":"Blunt carotid arterial injuries: implications of a new grading scale","volume":"47","author":"Biffl WL","year":"1999","unstructured":"Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Burch JM. Blunt carotid arterial injuries: implications of a new grading scale. J Trauma. 1999;47(5):845\u2013853."},{"issue":"1","key":"b15","series-title":"Semin Intervent Radiol","first-page":"53","article-title":"Endovascular considerations in traumatic injury of the carotid and vertebral arteries","volume":"38","author":"Vellimana AK","year":"2021","unstructured":"Vellimana AK, Lavie J, Chatterjee AR. Endovascular considerations in traumatic injury of the carotid and vertebral arteries. Semin Intervent Radiol. 2021;38(1):53\u201363."},{"issue":"4","key":"b16","series-title":"J Vasc Surg","first-page":"1323","article-title":"Timing of intervention may influence outcomes in blunt injury to the carotid artery","volume":"71","author":"Blitzer DN","year":"2020","unstructured":"Blitzer DN, Ottochian M, O\u2019Connor JV,  Timing of intervention may influence outcomes in blunt injury to the carotid artery. J Vasc Surg. 2020;71(4):1323\u20131332.e5."},{"issue":"5","key":"b17","series-title":"J Neurosurg","first-page":"1196","article-title":"Clinical and radiographic outcomes following traumatic Grade 1 and 2 carotid artery injuries: a 10-year retrospective analysis from a Level I trauma center. The Parkland Carotid and Vertebral Artery Injury Survey","volume":"122","author":"Scott WW","year":"2015","unstructured":"Scott WW, Sharp S, Figueroa SA,  Clinical and radiographic outcomes following traumatic Grade 1 and 2 carotid artery injuries: a 10-year retrospective analysis from a Level I trauma center. The Parkland Carotid and Vertebral Artery Injury Survey. J Neurosurg. 2015;122(5):1196\u20131201."},{"issue":"2","key":"b18","series-title":"J Trauma","first-page":"471","article-title":"Blunt cerebrovascular injury practice management guidelines: the Eastern Association for the Surgery of Trauma","volume":"68","author":"Bromberg WJ","year":"2010","unstructured":"Bromberg WJ, Collier BC, Diebel LN,  Blunt cerebrovascular injury practice management guidelines: the Eastern Association for the Surgery of Trauma. J Trauma. 2010;68(2):471\u2013477."},{"issue":"Suppl 2","key":"b19","series-title":"Neurosurgery","first-page":"234","article-title":"Management of vertebral artery injuries following non-penetrating cervical trauma","volume":"72","author":"Harrigan MR","year":"2013","unstructured":"Harrigan MR, Hadley MN, Dhall SS,  Management of vertebral artery injuries following non-penetrating cervical trauma. Neurosurgery. 2013;72(Suppl 2):234-243."},{"issue":"4","key":"b20","series-title":"Lancet Neurol","first-page":"361","article-title":"Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial","volume":"14","author":"Markus HS","year":"2015","unstructured":"Markus HS, Hayter E, Levi C, Feldman A, Venables G, Norris J. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Lancet Neurol. 2015;14(4):361\u2013367."},{"issue":"1","key":"b21","series-title":"J Neurointerv Surg","first-page":"47","article-title":"Current trends in endovascular management of traumatic cerebrovascular injury","volume":"6","author":"Kansagra AP","year":"2014","unstructured":"Kansagra AP, Cooke DL, English JD,  Current trends in endovascular management of traumatic cerebrovascular injury. J Neurointerv Surg. 2014;6(1):47\u201350."},{"issue":"1","key":"b22","series-title":"Semin Intervent Radiol","first-page":"44","article-title":"Endovascular management of neurovascular arterial injuries in the face and neck","volume":"27","author":"Radvany MG","year":"2010","unstructured":"Radvany MG, Gailloud P. Endovascular management of neurovascular arterial injuries in the face and neck. Semin Intervent Radiol. 2010;27(1):44\u201354."},{"issue":"8","key":"b23","series-title":"J Neurointerv Surg","first-page":"e31","article-title":"Covered stents for exclusion of iatrogenic common carotid artery-internal jugular vein fistula and brachiocephalic artery pseudoaneurysm","volume":"8","author":"Kooraki S","year":"2016","unstructured":"Kooraki S, Grohmann J, Elshikh S, Urbach H, Meckel S. Covered stents for exclusion of iatrogenic common carotid artery-internal jugular vein fistula and brachiocephalic artery pseudoaneurysm. J Neurointerv Surg. 2016;8(8):e31."},{"issue":"1","key":"b24","series-title":"J Trauma Acute Care Surg","first-page":"216","article-title":"Single-center experience on endovascular reconstruction of traumatic internal carotid artery dissections","volume":"72","author":"Cohen JE","year":"2012","unstructured":"Cohen JE, Gomori JM, Itshayek E,  Single-center experience on endovascular reconstruction of traumatic internal carotid artery dissections. J Trauma Acute Care Surg. 2012;72(1):216\u2013221."},{"issue":"8","key":"b25","series-title":"AJNR Am J Neuroradiol","first-page":"1585","article-title":"Endovascular treatment of traumatic injuries of the vertebral artery","volume":"29","author":"Herrera DA","year":"2008","unstructured":"Herrera DA, Vargas SA, Dublin AB. Endovascular treatment of traumatic injuries of the vertebral artery. AJNR Am J Neuroradiol. 2008;29(8):1585\u20131589."},{"key":"b26","series-title":"Endovascular Today","article-title":"Overview of endovascular management of traumatic carotid lesions","author":"Yamada R","unstructured":"Yamada R, Miller C, Guimaraes M, Sch\u00f6nholz C. Overview of endovascular management of traumatic carotid lesions. Endovascular Today. January 2016. Accessed December 21, 2023.https:\/\/evtoday.com\/articles\/2016-jan\/overview-of-endovascular-management-of-traumatic-carotid-lesions"},{"key":"b27","series-title":"Front Neurol Neurosci","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1159\/000088157","article-title":"Prognosis of cervical artery dissection","volume":"20","author":"Touz\u00e9 E","year":"2005","unstructured":"Touz\u00e9 E, Gauvrit J, Meder J, Mas J. Prognosis of cervical artery dissection. 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