Traumatic rupture of the innominate artery

Abstract

Objective: Blunt traumatic rupture of the innominate artery is uncommon. We reviewed our experience to correlate the impact of patient stability, presence of associated injuries and location of the injury within the artery with outcome.

Methods: A retrospective review was performed of patients admitted between January 1, 1998 and December 17, 2002 with traumatic innominate artery rupture. Injuries were defined as proximal if they were <or=0.5cm from the origin, distal if <or=0.5cm from the bifurcation and middle if in between.

Results: Over the 5-year study period, 66 patients were admitted with aortic or great vessel injury, including eight with blunt innominate artery disruption. Of the blunt innominate injuries, six involved the origin (five repaired by ascending aortic-innominate artery graft followed by over-sewing of the injury site, one by ligation alone), one middle (treated by interposition graft) and one distal (managed with resection and primary anastomosis). Four of the patients with proximal injuries had evidence of active bleeding (large expanding hematoma and/or frank bleeding) requiring control of the injury site prior to reconstruction. All patients had associated injuries (including closed head injury in three and splenic rupture in two). The only mortality occurred in a patient who presented in shock, and suffered tracheal rupture and severe blunt cardiac injury requiring cardiopulmonary bypass. The remaining patients were stable on presentation. Diagnosis was suspected after chest X-ray demonstrated widened mediastinum and was confirmed with either angiography or computer tomography scan. There were no complications in the survivors. Neither cardiopulmonary bypass nor aorto-carotid shunting was utilized in these cases.

Conclusions: Patients with blunt innominate artery rupture who survive to admission are usually stable and the diagnosis is suggested by initial chest radiograph. The injuries are usually proximal, requiring aortic-distal innominate bypass. Cardiopulmonary bypass is required only if there is evidence of heart failure (either before or after partial occlusion of the aorta) or to manage specific associated injuries.