Blunt Partial Transection of the Innominate Artery

Abstract

Introduction Innominate artery injury occurs, although rare. The innominate artery is the second most common aortic vessel injured as a result of blunt trauma. A blunt mechanism has been associated with up to 35% of innominate artery injuries. Associated innominate artery injuries include aortic or aortic branch injury, pneumothorax, rib fracture, head trauma, and long bone extremity fracture. Traditionally, surgical correction has been the preferred management option. Surgical options include the use of a graft verses primary repair, a bypass exclusion technique, cardiopulmonary bypass, and profound hypothermia or shunts, especially to maintain or protect cerebral perfusion. Stenting is another treatment option. The use and timing of these interventions depends on the characteristics of the innominate artery injury, associated concomitant injuries, resources of the facility, and comfort level of the surgeon. The branching pattern of the human aortic arch is varied. These variations should be kept in mind when dealing with great vessel injuries. The term “bovine arch” will not be used to describe the aortic arch branching pattern anomaly found in the current case as a true bovine arch involves a large brachiocephalic trunk that gives rise to both subclavian arteries and a bicarotid trunk. Two forms of human anomalous arch anatomy have been described as a bovine arch. The first arch variant is characterized as having a common origin of the innominate artery and the left common carotid artery. In a report by Layton and colleagues, they indicated that this variant occurred in approximately 13% of patients. He also reported that the second variant, in which the origin of the left common carotid artery arises from the innominate artery, occurs in less than 10% of the general population. The presence of these anomalies may contribute to the location of a great vessel injury as well as influence the management of the resulting injury in regards to maintaining cerebral perfusion. We report the case of an innominate artery injury in a man with anomalous arch circulation and our management of the injury.