Blunt injuries to the aortic arch vessels.

Thirty patients with 33 vascular injuries from blunt trauma to the brachiocephalic branches of the aortic arch are reported. To our knowledge, this is the largest series reported to date of blunt injuries to these vessels. Mechanisms of injury included deceleration, traction, and crush. Half of the injured vessels were the innominate artery, and a quarter each were the common carotid and subclavian arteries. Common associated injuries were head injuries, hemopneumothorax, lung contusion, long bone fractures, and brachioplexus injuries. Widened mediastinum and extrapleural hematoma were common radiographic findings, and aortic rupture was frequently suspected. Angiography was performed in all patients to identify precisely the nature and site of the injury. Surgical approaches varied with the anatomical site of the injury and required consideration of vascular control in chest, neck, and upper extremity. Twenty-seven patients are alive 6 months to 10 years after injury. Eighteen of 20 vascular reconstructions were patent at follow-up. No patient with brachioplexus injury had return of neurological function.