incidence of BCVI is 0.19–0.67 % for unscreened popula- tions and 0.6–1.

07 % for
screened populations. The recognition and treatment of BCVI has evolved dramatically over
the past two decades. As imaging technology has improved with respect to both image
quality and acquisition times, CT has become a fundamental diagnostic tool in blunt trauma
evaluation.

Evaluation
Computed tomography is the workhorse of trauma evaluation and should be the initial
diagnostic step in patients with penetrating neck injuries but no hard signs of vascular injury.
Computed tomographic angiography (CTA) has a 90 % sensitivity and 100 % specificity for
vascular injuries that require treatment. Occult injuries (intimal flaps, dissections,
pseudoaneurysms) identified during the evaluation for penetrating cervical injury should be
considered for management similar to those caused by blunt trauma. Table 1.3 summarizes
the evaluation criterion from three major investigator groups that should trigger CTA in the
evaluation of blunt cervical vessel injuries. CTA evaluation should always include the head
and neck, and if zone I injuries are suspected, the aortic arch should also be included. This
can be completed with a single contrast bolus in a well-timed exam.

Carotid Artery Injuries

Treatment of Blunt Injuries I–IV
The mainstay of treatment for BCVI grades I–IV is antithrombotic therapy, traditionally with
heparin infusion followed by warfarin therapy. Because of the concern for full
anticoagulation of the recent trauma patient, others have investigated the use of
antiplatelet therapy alone. Some have found lower stroke rates with heparin compared to
antiplatelet therapy. Unfortunately, there are no prospective head-to-head trials of heparin
versus