Management of major acute thoracic vascular injuries

Abstract

This report concerns thirty-nine cases of thoracic vascular injury. There were twenty-one cases of great vessel injuries in area I (thoracic inlet and upper thorax) including the ascending aorta (one), innominate artery (six), left common carotid artery (two), aortic arch (one), left subclavian artery (four), right subclavian artery (one), superior vena cava (two), innominate veins (one), and axillary arteries (three). Six were due to blunt trauma and fifteen were due to penetrating trauma including tracheal-innominate artery fistulas. There were seven injuries in area II (pulmonary arteries and veins). In area III there were eleven injuries of the descending thoracic aorta. Nine of these ruptured secondary to blunt trauma, one was a penetrating injury of the heart and aorta, and one was a penetrating aortic injury with a bullet embolus. A discussion is presented of the surgical approaches for the different vascular injuries of the thorax including different methods of repair of ruptures of the descending thoracic aorta.