Management of Great Vessel Injury

  • Stephen C. Nicholls


The great vessels and their major branches traverse the superior mediastinum, thoracic outlet and the neck. Understandably, injuries to these vessels constitute one of the most challenging acute problems confronting the surgeon. Vascular injuries in this area constitute approximately 12% of all vascular trauma and the majority are penetrating injuries. Hemorrhage from brachiocephalic arteries and branches is frequently associated with injuries to adjacent vital structures, and this accounts not only for the high mortality at the scene or in transit, but also for severe hypotension of patients on arrival in the emergency room. When survival occurs, priorities are for immediate resuscitation, recognition of the true extent and complexity of the injury, and prompt operative intervention for access, control and repair of vessels. Blunt trauma is less common, but can be particularly difficult to manage when it involves the airway. The sudden deceleration forces involved in road traffic accidents may result in hyperextension injuries of the carotid and vertebral arteries which may occur in the absence of bony injury. Diagnosis of these injuries can be difficult as initially they are often unaccompanied by neurological deficits and the consequences of missing such injuries may be devastating. Neurological deficits, when present, may include cranial nerve palsies and Horner’s syndrome in addition to hemispheric ischemia.


Vertebral Artery Subclavian Artery Blunt Trauma Median Sternotomy Artery Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Selected References

  1. Du Toit DF, Strauss DC, Baszczyk M.,de Villers R., Warren BL; Endovascular treatment of penetrating thoracic outlet arterial injuries. Eur J Vase Endovasc Surg 2000 May; 19(5):489–95.CrossRefGoogle Scholar
  2. Feliciano, DV: Management of penetrating injuries to carotid artery. World J Surg 2001: Aug;25 (8): 1028–35.PubMedCrossRefGoogle Scholar
  3. Johnson RH, Wall MJ, Mattox KL. Innominate artery trauma: a thirty-year experience. J Vase Surg 1993:17:134–9.CrossRefGoogle Scholar
  4. Manord JD. Garrard CL, Kline DG, Sternbergh WC, Money SR. Management of severe proximal vascular and neural injury of the upper extremity. J Vase Surg 1998;27:43–9.CrossRefGoogle Scholar
  5. Marin ML, Veith FJ, Panetta TF, Cynamon J. Sanchez, LA Schwarts, ML, Lyon T, Bakal CW Suggs WD, Transluminal placed endovascular stented graft repair for arterial trauma. J Vase Surg 1994 Sep;20(3):466–72.CrossRefGoogle Scholar
  6. Mattox KL, Feliciano DV, Burch J, et al. Five thousand seven hundred sixty cardiovascular injuries in 4459 patients. Ann Surg 1989;209:698–707.PubMedCrossRefGoogle Scholar
  7. Patel AV, Marin ML, Veith FJ: Endovascular graft repair of penetrating subclavian artery injuries. J Endovasc Surg 3:382–388, 1996.PubMedCrossRefGoogle Scholar
  8. Prettier R, Chilcott M, Murith N, Panos A. Blunt injury to the supra-aortic arteries.Br J Surg 1997;84:603–9.CrossRefGoogle Scholar
  9. Rosenberg JM, Bredenberg CE, Marvasti MA, et al. Blunt injuries to the aortic arch vessels. Ann Thorac Surg 1989;48:508–13.PubMedCrossRefGoogle Scholar
  10. RheeRY, Gloviczki P, Cherry KJ. Management of injuries to branches of the aortic arch. Sem in Vase Surg 1996;9:147–55.Google Scholar
  11. Abouljoud MS, Obeid FN, Horst HM, et al: Arterial injuries of the thoracic outlet: A ten-year experience. Am Surg 1993 59:590–595.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • Stephen C. Nicholls

There are no affiliations available

Personalised recommendations