Beyond the Bleed: Characterization of Traumatic Head and Neck Pseudoaneurysms in the Facial Trauma Patient

Traumatic head and neck pseudoaneurysms are rare, potentially life-threatening vascular injuries that may accompany craniomaxillofacial trauma. This retrospective observational cohort study characterizes the presentation, management, and outcomes of these injuries in civilian patients treated at academic level I to II urban trauma centers from January 2009 to May 2025. Patients were identified using ICD-9/10 codes, and variables included demographics, injury mechanism, vessel location, imaging, associated injuries, treatment modality, complications, and outcomes. The primary outcome was the rate of intervention required; secondary outcomes included the intervention type, intraoperative hemorrhage rate, delayed bleeding incidence, need for delayed fracture repair, and survival to discharge. Seventeen patients were identified with a mean age of 38.8 years and 88.2% male predominance. Penetrating trauma accounted for 52.9% of injuries. The vertebral (29.4%), internal carotid (17.6%), and subclavian (17.6%) arteries were most commonly involved. Concomitant craniomaxillofacial fractures occurred in 47.1% of patients, with the vertebral artery disproportionately involved in this subgroup (62.5%, P=0.009). For the primary outcome, 70.6% of patients ultimately required intervention. Endovascular techniques were preferred over open repair (58.3% versus 41.7%). Only 41.2% of patients presented with significant bleeding immediately after injury, while 17.6% experienced delayed bleeding. Delayed fracture repair to prioritize vascular intervention occurred in 12.5% of patients. All patients survived to hospital discharge despite a 58.3% intraoperative hemorrhage rate. These findings suggest traumatic head and neck pseudoaneurysms frequently require intervention but rarely necessitate delayed facial fracture management with coordinated multidisciplinary care. A low threshold for CTA screening in high-risk craniomaxillofacial trauma patients enables early detection and favorable outcomes.