Management of closed injuries of the innominate artery

Two cases of closed traumatic rupture of the innominate artery are described. Both patients underwent surgical reconstruction, for which one patient was cooled to 15 degrees C on cardiopulmonary bypass. In the management of these rare and severe injuries, which almost invariably need surgical repair, protection of the cerebral circulation is vital; cerebral blood flow and function should be monitored during the operation, for which cardiopulmonary bypass, hypothermia, or local shunting should be available. Failure to recognise the features of these injuries lead to a high death rate, and aortography should be performed whenever there is clinical or radiological suspicion.