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Invited Commentary
September 2015

Important Clarifications About Treating Indeterminate Vascular Injuries to the Neck

Author Affiliations
  • 1Division of Vascular Surgery, Stanford University Medical Center, Stanford, California
JAMA Surg. 2015;150(9):847-848. doi:10.1001/jamasurg.2015.1731

The increasing reliance on and relative availability of high-quality cross-sectional imaging of vascular structures has altered the workup of patients with blunt trauma. Traditional 2-dimensional angiography and the extensive resources necessary to perform these procedures in critically injured patients have largely been replaced by rapid computed tomography angiography and 3-dimensional reconstructions; therefore, the early diagnosis and treatment of vascular injuries in patients with blunt trauma have undergone a paradigm shift. Neck injury provides a particularly challenging subcohort of patients with trauma because it is often difficult to predict the progression of carotid and vertebral injuries and its effect on neurologic status. Crawford et al1 presented a timely and contemporary study of 100 patients with 138 blunt cerebrovascular injuries (BCVIs), focusing on the more challenging diagnostic dilemma of the indeterminate injury.

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