Avulsion of the innominate artery from the aortic arch associated with a posterior tracheal tear.

The management of a patient with avulsion of the innominate artery from the aortic arch associated with a longitudinal tear on the posterior aspect of the trachea is discussed. It is obviously important to make both diagnoses preoperatively to determine priorities in the surgical management. If the airway injury can be managed by tracheal intubation, then it is recommended that the vascular injury be repaired first. If there is a persistent air leak with respiratory distress, then it is necessary to repair the tracheal injury before performing the vascular procedure. In some patients it may be appropriate to treat the tracheal injury nonoperatively.