Innominate Artery Injury

Excerpt

Innominate artery injury is a rare but lethal injury. Most injuries are due to blunt trauma rather than penetrating injury. Injury to the innominate artery occurs in multiple different manners, including blunt, penetrating, or iatrogenic trauma. The innominate artery is also known as the brachiocephalic artery. Injury to the innominate artery requires fast diagnosis and a skilled surgeon to repair the injury, whether by open or endovascular repair.

Thoracic, vascular injuries, especially innominate artery injuries, require the surgeon to make swift decisions for repair as the wrong approach or incision can quickly lead to mortality. The surgeon must gain control over immediate hemorrhage to help prevent malperfusion to distal organs, the formation of pseudoaneurysms, or the rupture of the artery. Over the years, increasing technology has allowed improved imaging and approaches for diagnosis and management of innominate artery injuries. With the increase in diagnostic modalities, patients can now undergo open, endovascular, or non-operative management for traumatic injuries to the innominate artery.

The innominate artery branches off the proximal portion of the aortic arch and divides into the right common carotid and subclavian arteries, whereas the left common carotid artery and subclavian artery branch directly off the distal portion of the aortic arch. This is the normal aortic arch configuration and presents in 70 to 74% of the population.

Abnormal configurations of the aortic arch must also be considered, the most common being a bovine aortic arch when the left common carotid artery either shares a common origin (subtype 2) with the innominate artery or branches directly off it less than 1 cm above the arch (subtype 1). Subtype 1 and subtype 2 bovine aortic arches are present in 9% and 13 to 20% of the population, respectively. Other less common aortic arch anomalies include aberrant left vertebral artery, aberrant right subclavian artery, aberrant left subclavian artery, and right aortic arch.