INNOMINATE-ARTERY TRAUMA - A 30-YEAR EXPERIENCE

Purpose: Injury to the innominate artery may represent a zone I cervical, thoracic outlet, or intrathoracic vascular injury and poses diagnostic, exposure, and management problems for the general, vascular, and thoracic surgeon. This complex injury often becomes a new learning experience with each infrequent encounter. Methods: Between 1960 and 1992 43 patients with innominate artery injuries were treated. Penetrating injuries were from gunshot wounds in 25, stab wounds in 7, and shotgun wounds in 2 patients. Blunt injuries accounted for seven of the patients. In 28 patients there were multiple injuries, including multiple vascular injuries. Median sternotomy was used in all planned operations in the later part of the study, and bilateral transsternal anterolateral thoracotomy was used in patients undergoing urgent or emergency center thoracotomy. Results: Blunt injury resulted in tears near the aortic arch with intimal disruption. Bypass grafting without hypothermia, shunts, or systemic heparinization is now used in all patients. Thirty-two patients survived to leave the hospital with no new complications related to the procedure. Postoperative neurologic complications were associated with preexisting neurologic deficits. Conclusions: Patients with innominate artery injury and stable vital signs can usually be transported without difficulty and treated without complex perioperative adjuncts. These patients can undergo revascularization with simple vascular surgical techniques and should expect an uncomplicated postoperative course unless there has been associated central nervous system injury or related injuries leading to systemic infection. Synthetic conduits have been used with success and have not required systemic heparinization or complex temporary shunting.