Dissection traumatique du tronc artériel brachiocéphalique. À propos d’un cas

Abstract

Lesions affecting the supra-aortic arterial trunks often occur in a contest of severe chest trauma. They are rarely isolated and can be life-threatening. We report a case of surgery for an isolated traumatic dissection of the innominate artery. A 48-year-old patient had a road accident causing head injury, trauma of the left lower limb and blunt chest trauma. At the physical exam, the pulse at the upper right limb was weak compared to the contralateral member. A pressure gradient of 50mm Hg was recorded between the two upper limbs. A whole body scan revealed a dissection of the innominate artery sparing its origin and bifurcation. Cervicotomy and sternotomy was necessary to achieve control. After heparinization and clamping, a prosthetic bypass was inserted to replace the innominate artery. The postoperative course was uneventful and the pressure gradient between the two upper limbs disappeared. Lesions of the brachiocephalic arterial trunk are not frequent but they are serious. A careful physical exam at admission helps detect them. Prognosis is directly linked to early diagnosis and management. Conventional surgery provides good results and remains the standard treatment for these lesions.