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[Trauma of the brachiocephalic trunk]
Fady Francis1, Yves Castier, Sacha Mussot
1Service de chirurgie vasculaire et thoracique, Hôpital Beaujon, 100, Boulevard du Général Leclerc, 92110 Clichy. guy.leseche@bjn.ap-hop-paris.fr
Presse Medicale (Paris, France : 1983)
|August 1, 2002
Summary
Non-iatrogenic brachiocephalic arterial trunk (BCAT) traumas are rare but require prompt diagnosis and management. Advances in imaging and specialized care have improved outcomes for these severe injuries.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Thoracic Surgery
Context:
- Non-iatrogenic traumas to the brachiocephalic arterial trunk (BCAT) are uncommon.
- Open traumas typically affect the distal BCAT, while closed traumas result from deceleration injuries affecting the proximal BCAT.
- Diagnosis should be considered in patients with severe trauma or neck/chest wounds.
Purpose:
- To outline diagnostic circumstances and surgical management of brachiocephalic arterial trunk traumas.
- To discuss the treatment approaches for open and closed BCAT injuries.
- To highlight the challenges and management of tracheobronchial-BCAT fistulas.
Summary:
- Non-iatrogenic BCAT traumas necessitate prompt recognition, with thoracic radiography and arteriography being crucial diagnostic tools.
- Cervico-sternotomy is the preferred surgical approach; direct repair is used for open traumas, while bypass and suture are employed for closed traumas.
- Tracheobronchial-BCAT fistulas complicate tracheotomy, requiring preventive measures and urgent surgical intervention, often with a guarded prognosis.
Impact:
- Improved diagnostic capabilities and specialized emergency care have reduced mortality rates for BCAT injuries over the past three decades.
- Effective management strategies are crucial for improving patient outcomes in cases of BCAT trauma.
- Understanding and addressing concomitant lesions are vital for successful therapeutic management and prognosis.