[Lesions of the supra-aortic arterial trunks by closed trauma].

Thirteen patients treated for 14 arterial lesions of the supra-aortic trunks from blunt trauma between 1985 and 1993 were retrospectively reviewed. In 2 cases, the lesion was on the innominate artery, in 1 case on the right common carotid artery and in 11 cases on the subclavian artery. It consisted of rupture in 8 cases, pseudoaneurysm in 5 and occlusion from an intimal flap in 1 case. Acute ischemia of the upper limb was present in 5 patients, and severe local hemorrhage in 1 patient. Four patients (5 lesions) did not have symptoms on initial hospitalization. Two later suffered embolisms from a pseudoaneurysm with a fatal outcome from massive cerebral ischemia in one case. Eleven arteries were repaired and two were ligated because of massive associated soft tissue destruction of the shoulder and the arm requiring immediate amputation. In addition to these two amputations, a brachial plexus injury remained disabling for 4 other patients. Blunt injuries of the supra-aortic arterial trunks constitute an immediate challenge in the case of active bleeding and often require combined mediastinal or thoracic and cervical exposure. They carry a heavy morbidity when the subclavian artery is involved due to associated soft tissue or brachial plexus damage. Occult lesions of the arteries supplying the brain are dangerous because of the risk of interference with cerebral blood flow. They should be actively investigated and, if the distal part of the lesion is accessible, they should be treated surgically.