Bishop Michael A., Akbani Mohammed J.
Advent Health Orlando
Mercy St. Vincent Medical Center
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.
无名动脉损伤是一种罕见但致命的损伤。大多数损伤是由钝性创伤而非穿透性损伤引起的。无名动脉损伤以多种不同方式发生，包括钝性、穿透性或医源性创伤。无名动脉也被称为头臂干动脉。无名动脉损伤需要快速诊断，并由技术娴熟的外科医生进行修复，无论是通过开放手术还是血管内修复。胸部血管损伤，尤其是无名动脉损伤，要求外科医生迅速做出修复决策，因为错误的方法或切口可能很快导致死亡。外科医生必须控制立即出血，以帮助防止远端器官灌注不良、假性动脉瘤形成或动脉破裂。多年来，技术的不断进步使得无名动脉损伤的诊断和管理在成像和方法上都有所改进。随着诊断方式的增加，现在患者对于无名动脉创伤可以接受开放手术、血管内治疗或非手术治疗。无名动脉从主动脉弓近端分支，分为右颈总动脉和锁骨下动脉，而左颈总动脉和锁骨下动脉直接从主动脉弓远端分支。这是正常的主动脉弓构型，在70%至74%的人群中存在。还必须考虑主动脉弓的异常构型，最常见的是牛型主动脉弓，即左颈总动脉与无名动脉共用一个共同起源（2型亚型）或在主动脉弓上方不到1厘米处直接从无名动脉分支（1型亚型）。1型和2型牛型主动脉弓分别存在于9%和13%至20%的人群中。其他较不常见的主动脉弓异常包括左侧椎动脉异常、右侧锁骨下动脉异常、左侧锁骨下动脉异常和右位主动脉弓。
