Cervicomediastinal injuries following blunt trauma.

Blunt injuries to aortic arch branches are encountered with increasing frequency. From 1976 to 1980 20 patients with 26 cervicomediastinal arterial injuries were treated. Physical findings varied depending on the vessel injured: all subclavian artery injuries had positive signs, one carotid artery injury had a bruit as the only finding, and injuries to the innominate artery had no positive physical findings. Angiographic examination was performed in all patients when findings suggested vascular injury or there was a high index of suspicion based on patient history, widened mediastinum, or first rib fracture. Vessels injured included the subclavian (13 instances), carotid (five instances), innominate (five instances) and vertebral (three instances). In injured vertebral arteries were ligated. Innominate artery wounds were reconstructed using Dacron grafts; the remainder were excised in the area of intimal damage with primary anastomosis or interposition of a saphenous vein graft. There were no deaths or major vascular complications. Three patients, each, have major upper extremity neurologic deficits due to brachial plexus stretch injuries.