Blunt injuries to branches of the aortic arch.

Blunt injuries to branches of the aortic arch are not unusual and must be considered in any patient surviving deceleration or crush injury. Review of 36 case reports, including own own case, revealed 22 injuries to the innominate artery (4 with injuries to other arch branches), seven to the right subclavian, seven to the left subclavian, and eleven associated injuries to the thoracic aorta. Thirty patients (83 per cent) survived. Mediastinal widening (92 per cent) was the most frequent manifestation of vascular injury and is an indication for immediate aortography to delineate the entire thoracic aorta. Distal circulation was clinically decreased in less than 50 per cent, with symptomatic ischemia in only a few instances. Death was due to associated head injury in 3 of 6 cases. Earlier operation would have avoided exsanguination (one death) and late complications of false aneurysm or vascular insufficiency (10 patients).