Injuries to the ascending aorta, aortic arch and great vessels

During the past decade (1977 to 1987), 46 patients with 51 arterial injuries to the ascending aorta, aortic arch and great vessels have been treated at our institution. There were 25 subclavian arterial, 17 common carotid arterial, five innominate arterial and four ascending aortic injuries. Sixteen (35 per cent) patients were hemodynamically unstable at admission and required immediate operative intervention. Two patients arrived in cardiac arrest, necessitating thoracotomy performed in the emergency room. Thirty (65 per cent) patients were hemodynamically stable and underwent emergent diagnostic angiography prior to arterial repair. Lateral or end to end arterial repairs were used in the majority. Two ascending aortic injuries required cardiopulmonary bypass. Forty-three of 46 patients survived. Prompt exploration in the unstable patient, diagnostic angiography in the stable patient and a systematic but flexible operative approach are the keys to the management of these potentially lethal injuries.