Avulsion of the innominate vein during median sternotomy

Two cases of disinsertion of the left innominate vein from the superior vena cava (S.V.C.) during primary median sternotomy have been encountered during the past 6 years. Methods of management consisting of either (1) ligation and division of the left innominate vein and patch angioplasty of the SVC injury, or (2) patch angioplasty of the disinsertion injury itself with preservation of the left innominate vein are presented. The rationale and possible complications of each method of treatment are discussed based on the anatomy and collateral circulation of the left innominate vein and other experiences with division of the left innominate vein.