症例は43歳の男性，バイク乗車中の事故で受傷した。当院搬入時ショックバイタルであり外傷蘇生を行いながら原因検索を施行し，CT検査で造影剤の血管外漏出を伴うGrade Vの左椎骨動脈損傷を認めた。頸部圧迫止血法で損傷部を圧迫しながら血管内治療を行い止血を得た。集中治療を経て全身状態安定し,リハビリ継続目的に転院となった。椎骨動脈損傷は解剖学的に止血困難なことや所見が見逃されやすいことなどから死亡率が高く，活動性出血を伴うGrade Vの救命率はとくに低い。本症例は出血部位への解剖学的アプローチが難しい損傷であったが，複数の治療手段を戦略的に組み合わせることで救命できた。 A 43–year–old male sustained injury in a traffic accident while riding his motorcycle. The patient presented with low blood pressure at the time of visit. Therefore, we performed trauma resuscitation and searched for the cause. The contrast–enhanced CT examination revealed a left vertebral artery injury with extravasation. We applied the hemostatic method of cervical compression and treated this patient endovascularly. The patient was then hospitalized in the intensive care unit and had an orthopedic surgery. Consequently, he was transferred for rehabilitation. The reason for the high mortality rate in vertebral artery injuries is the difficulty to stop bleeding, owing to its anatomical position. In addition, physical and CT findings may be easily overlooked. There are several lifesaving cases of vertebral artery injury with extravasation (Grade V). Identified that the strategic and appropriate combination of multiple hemostatic methods can save patients with the injuries that are very difficult to approach.
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