Blunt injuries of the brachiocephalic artery

Blunt injury of the brachiocephalic artery can pose diagnostic and management problems for the trauma and thoracic surgeon. To arrive at recommendations for dealing with this injury, we reviewed a seven-year experience at our trauma center. Between 1988 and 1995, five patients presented with blunt injuries of the brachiocephalic artery. All patients were stabilized and underwent repair through a median sternotomy with extension of the incision anterior to the sternocleidomastoid muscle. All patients had restoration of flow to the subclavian and carotid arteries utilizing bypass grafts (4) or primary repair (1). All patients survived to leave the hospital with no complications related to the procedure. Postoperative neurologic findings were present before the operative repair. Patients with blunt injuries of the brachiocephalic artery should be stabilized, and circulation of the subclavian and carotid arteries should be restored with graft placement or primary repair. Cardiopulmonary bypass and heparin or temporary shunts were not needed in this series of patients. Complications were related to associated injuries.