Analysis of blunt and penetrating injury of the innominate and subclavian arteries.

Injury to the innominate or subclavian artery is an uncommon but difficult management problem. Review of trauma admissions from August 1983 to August 1992 revealed 21 patients who sustained injury to the innominate or subclavian artery. Eight patients sustained blunt trauma, while 13 patients sustained penetrating injuries. The mechanism of injury was variable, and associated injuries were common in both blunt and penetrating trauma. Injuries involved the right innominate or subclavian artery in 10 patients and the left subclavian artery in 11 patients. Twenty patients were managed operatively. Primary repair was preferred for penetrating injuries, whereas a bypass graft was more common for blunt injuries (P = 0.41). Patients with penetrating injury were more unstable at presentation (admission systolic blood pressure 73 mm Hg vs 119 mm Hg, P = 0.006; preoperative evaluation time 66 min vs 319 min, P = 0.002) and required more blood transfusions (5 units vs 26 units, P = 0.007) than patients with blunt injuries. Mortality for the entire series was 24 per cent (0% blunt vs 38% penetrating, P = 0.047). Hospital days (28 vs 48) and ICU days (8 vs 14) were longer for survivors of penetrating injuries (P = NS). Complications were common in both groups. Innominate/subclavian artery injury remains a significant cause of mortality and morbidity.