Rupture of the innominate artery from blunt trauma: Current options for management

Background. Rupture of the innominate artery is the second most common intrathoracic arterial injury from blunt trauma. It is frequently accompanied by major trauma to other organs. The traditional management is expeditious surgical repair. Methods: Three patients presented to the Emergency Department after motor vehicle collisions with traumatic rupture of the innominate artery from 2001 to 2003. One patient presented with an isolated innominate artery injury. The other two patients presented with multisystem trauma. All patients underwent surgical repair; however, repair was individualized in each case. Results: Diagnosis was obtained via arteriography in all patients after the admission chest radiographs suggested mediastinal injury. In the patient with isolated traumatic innominate artery rupture, urgent repair was performed. In the remaining two, the repair was intentionally delayed (hospital day 4 and 19) until they stabilized or recovered from other injuries or complications. In one of these patients, repair was delayed after an endovascular repair failed. In both patients who underwent delayed repair, mean arterial pressure was maintained at < 70 mmHg with beta-blockade. All patients underwent repair without cardiopulmonary bypass and were monitored for adequate cerebral perfusion pressures by measuring the right carotid artery stump pressure. Successful repair was achieved in all the three patients without postoperative complications or mortality. Conclusions: Rupture of the innominate artery from blunt trauma is an infrequent but life-threatening injury that mandates repair. In patients with isolated injuries, prompt intervention is warranted. However, intentional delayed repair may be a practical alternative for those patients with multisystem trauma.