Vascular injuries of the upper thorax and the root of the neck

Abstract

The great danger of injury to the branches of the arch of the aorta near their origin is the occurrence of severe uncontrolled haemorrhage. Five cases of traumatic injury to the branches of the aortic arch are presented. In the first case the innominate artery was ruptured near its origin and was repaired with a Dacron prosthesis. In the second case the left subclavian and the left common carotid arteries were cut near their origins and these vessels were ligated in an attempt to preserve life following severe unexpected haemorrhage. The patient recovered but developed a left subclavian steal syndrome. A third case developed a right subclavian artery aneurysm following a crush injury of the chest. The first right rib was also broken. In the fourth case a left subclavian steal syndrome developed 10 years after a crush injury to the upper chest. The fifth case, a 76-year-old man, had temporary ischaemic changes in his left hand following a crush injury to his chest. The left subclavian artery was thrombosed at its junction with the axillary artery as a result of a comminuted fracture of the left clavicle. The circulation to the left hand returned to normal 4 days following the injury.