Management ofclosed injuries oftheinnominate artery

Twocases ofclosed traumatic rupture oftheinnominate artery aredescribed. Both patients underwent surgical reconstruction, forwhichonepatient wascooled to15°Concar- diopulmonary bypass. Inthemanagement ofthese rareandsevere injuries, whichalmost invari- ablyneedsurgical repair, protection ofthecerebral circulation isvital; cerebral bloodflowand function should bemonitored during theoperation, forwhichcardiopulmonary bypass, hypothermia, orlocal shunting should beavailable. Failure torecognise thefeatures ofthese injuries lead toahigh death rate, andaortography should beperformed whenever there isclinical orradiological suspicion. Traumatic rupture oftheinnominate artery isa severe andfrequently fatal condition. Fortunately it israre, butinthis ageofrapid travel deceleration or direct chest injuries arebecoming morecommon,' especially inyoungpeople. Themanagement of innominate artery injuries isdifficult asthecerebral circulation mustbeprotected, andowing totherar- ityofthis condition anyonesurgeon's experience in dealing withitisboundtobelimited. We therefore report twocases oftraumatic rupture oftheinnomi- nateartery that reflect different aspects oftheman- agement ofthis severe injury.