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Blunt innominate artery injury
S Stover1, R B Holtzman, L Lottenberg
1Division of Trauma and Critical Care, Memorial Regional Hospital, Hollywood, Florida 33021, USA.
The American Surgeon
|August 21, 2001
Summary
Blunt innominate artery injuries are rare, often caused by high-speed crashes. A "shoulder strap sign" in trauma patients suggests potential for serious injury requiring further investigation.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Cardiovascular Imaging
Background:
- Innominate artery injuries are uncommon, with penetrating trauma being the predominant cause.
- Blunt innominate artery injuries are exceptionally rare, with fewer than 90 documented cases.
- High-speed motor vehicle accidents with sudden deceleration are implicated in blunt innominate artery injuries.
Observation:
- Two recent cases of blunt innominate artery injury treated successfully.
- Both patients sustained injuries in high-speed motor vehicle crashes while using restraints.
- Associated shoulder harness bruising, termed the "shoulder strap sign," was noted in both patients.
Findings:
- One patient presented with a wide mediastinum on chest X-ray, confirmed innominate artery injury via angiography.
- The second patient had a normal chest X-ray but suspicious findings on MR angiography, later confirmed by arch aortography.
- Both innominate artery disruptions were surgically repaired via median sternotomy.
Implications:
- The "shoulder strap sign" is a critical indicator for potential innominate artery injury in blunt trauma.
- Advances in safety restraint technology may lead to an increased incidence of this rare injury.
- Early recognition and diagnostic imaging are crucial for timely intervention and improved patient outcomes.