Treatment strategy for traumatic innominate arterial injury

Abstract

Purpose: To discuss and share the experience of treatment of traumatic innominate arterial injury.

Methods: A retrospective analysis was performed on patients with innominate arterial injuries admitted from January 2016 to July 2018 at the department of vascular surgery, Beijing Jishuitan Hospital, China. All the arterial injuries were confirmed by arteriography. Clinical data including mechanism of injury, type of injury, demographics, concomitant injuries, time interval from trauma to blood flow reconstruction, and operation methods were collected. Follow-up program included outpatient visit and duplex-ultrasonography. SPSS version 23.0 was adopted for data analysis. Categorical variables are presented as number and/or frequency and continuous variables as mean ± standard deviation.

Result: Altogether 7 patients were included and 6 (85.7%) were male. The mean age of patients was (29.43 ± 7.98) years, range 19-43 years. Six patients had isolated innominate arterial injuries and the rest 1 combined innominate arterial and vein injuries. The injury causes were road accidents in 3 patients, stab wound in 2, gunshot wound in 1, and crush injury in 1. All the 7 patients presented hemorrhagic shock at admission, which was timely and effectively corrected. No perioperative death or technical complications occurred. Intimal injury (n = 2) and partial transaction (n = 2) of the innominate artery were treated with covered stents. Two patients with complete transection of artery received vascular reconstruction by artificial grafts. One patient with partial transaction received balloon dilation and open surgical repair (hybrid operation). The mean time interval from trauma to blood flow reconstruction was (4.27 ± 0.18) h, range 4.0-4.5 h; while the operation time was (48.57 ± 19.94) min, range 25-75 min. Cerebral infarction occurred in one patient with brain injury due to anticoagulation contraindication. The average follow-up was (13.29 ± 5.65) months, range 6-24 months. No severe stenosis, occlusion, and thrombosis of covered stents or artificial vessels were found by color Doppler ultrasound.

Conclusion: Urgent control of hemorrhage and restoration of blood supply are critical for the treatment of traumatic innominate arterial injury. Endovascular therapy is a feasible and effective method with short operation time and less trauma.

Keywords: Endovascular procedures; Innominate artery; Surgical revascularization.

Fig. 1

A patient with a stab wound: the incision is about 2 cm long.

Fig. 2

Arteriography shows rupture of the innominate artery in a patient with a gunshot wound.

Fig. 3

Arteriography shows rupture of the innominate artery (A) in a patient with road accident, which was treated by covered stent placement (B).

Fig. 4

Venography shows covered stent placement for rupture of the innominate vein (A and B) in a patient with crush injury.

Fig. 5

Partial transection of the innominate artery (A) in a patient with a stab wound, for which vascular reconstruction is conducted by a polytetrafluoroethylene artificial graft (B).