Repair and survival of the innominate artery late after transection

Survival of major thoracic arteries transected by blunt trauma usually depends on immediate surgical repair. However, the authors report a case in which a 54-year-old man had survived an untreated complete transection of the innominate artery 20 years before. He presented with subclavian steal syndrome and transient ischemic attacks. There was wide separation between the proximal and distal stumps of the artery with no apparent continuity of tissue between them. A 10-mm Gore-Tex graft was successfully used as a bypass from the ascending aorta to the distal carotid bifurcation. Survival of the innominate artery transection without treatment and late onset of symptoms has not previously been described.