Traumatic avulsion of the innominate and left carotid arteries: successful repair

Traumatic rupture of the aorta or the arch vessels is a rare and frequently fatal injury. This lesion should be considered in all cases of severe chest trauma. Early aortography is essential for accurate diagnosis. Nineteen cases of avulsion of the innominate artery have been previously reported. In only two of them a second aortic arch branch had an associated injury. The case presented here is the first successful repair of a combined avulsion of both the innominate and the carotid arteries from the aortic arch. Cerebral circulation was maintained during the operation with a heparin-coated shunt from the ascending aorta to the right common carotid artery. Reconstruction was accomplished by inserting a bifurcated Dacron prosthesis from the aorta to the innominate and left carotid arteries. The use of a heparin-bonded shunt maintained cerebral perfusion, and greatly simplified the operation and avoided the risk of extracorporeal circulation and systemic anticoagulation in a patient with multiple trauma.