HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Riyad Karmy-Jones Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Karmy-Jones, R. Articles by King, S. Search for Related Content PubMed PubMed Citation Articles by Karmy-Jones, R. Articles by King, S. Related Collections Great vessels

Eur J Cardiothorac Surg 2003;23:782-787
© 2003 Elsevier Science NL

Traumatic rupture of the innominate artery

Department of Surgery, Section of Thoracic-Vascular Surgery, Harborview Medical Center, Box 359796, 325 Ninth Avenue, Seattle, WA 98104-2499, USA

Received 24 September 2002; received in revised form 30 December 2002; accepted 13 January 2003.

^* Corresponding author. Tel.: +1-206-731-5439; fax: +1-206-731-3656
e-mail: karmy{at}u.washington.edu

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 0.5 cm from the origin, distal if 0.5 cm 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.

Key Words: Blunt innominate artery • Trauma

This article has been cited by other articles:

				P. Rispoli, G. Varetto, F. M. Savia, and M. Rinaldi Large post-stenting innominate artery pseudoaneurysm Interactive CardioVascular and Thoracic Surgery, June 1, 2008; 7(3): 444 - 446. [Abstract] [Full Text] [PDF]

				C. W. Sliker, K. Shanmuganathan, and S. E. Mirvis Diagnosis of Blunt Cerebrovascular Injuries with 16-MDCT: Accuracy of Whole-Body MDCT Compared with Neck MDCT Angiography Am. J. Roentgenol., March 1, 2008; 190(3): 790 - 799. [Abstract] [Full Text] [PDF]

				M. W.A. Chu and M. L. Myers Traumatic innominate artery disruption and aortic valve rupture. Ann. Thorac. Surg., September 1, 2006; 82(3): 1095 - 1097. [Abstract] [Full Text] [PDF]

				The effect of changing presentation and management on the outcome of blunt rupture of the thoracic aorta. J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 594 - 600.

				S. Rubin, Y. A. Saade, H. Dayawa, and B. Baehrel Transection of left common carotid artery with arch extension after blunt chest trauma Interactive CardioVascular and Thoracic Surgery, December 1, 2004; 3(4): 608 - 611. [Abstract] [Full Text] [PDF]