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Innominate artery trauma: a thirty-year experience
R H Johnston1, M J Wall, K L Mattox
1Cora and Webb Mading Department of Surgery, Baylor College of Medicine, Houston, TX 77030.
Journal of Vascular Surgery
|January 1, 1993
Summary
Innominate artery injuries can be complex but are manageable with standard surgical techniques. Successful revascularization is achievable without complex adjuncts, leading to good outcomes for most patients.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Thoracic Surgery
Background:
- Innominate artery injuries present significant diagnostic and management challenges.
- These injuries can occur in the cervical, thoracic outlet, or intrathoracic regions.
- Each case often represents a unique learning experience due to the rarity of these injuries.
Purpose of the Study:
- To review the management and outcomes of patients with innominate artery injuries.
- To evaluate surgical techniques and adjuncts used in treating these complex vascular injuries.
- To identify factors influencing patient outcomes after innominate artery repair.
Main Methods:
- A retrospective review of 43 patients treated for innominate artery injuries between 1960 and 1992.
- Analysis of injury mechanisms, including penetrating (gunshot, stab, shotgun) and blunt trauma.
- Surgical approaches included median sternotomy and bilateral transsternal anterolateral thoracotomy.
Main Results:
- Bypass grafting without hypothermia, shunts, or systemic heparinization was successfully employed.
- 32 patients survived without new procedure-related complications.
- Postoperative neurologic complications were linked to pre-existing deficits.
Conclusions:
- Innominate artery injuries in stable patients can be managed with standard vascular surgical techniques.
- Revascularization can be achieved without complex perioperative adjuncts.
- Outcomes are generally uncomplicated unless associated with central nervous system injury or infection.