Repair of innominate artery injury

To repair injuries to the innominate artery, the mediastinum is explored through a median sternotomy. If hematoma obscures the view of the the left innominate vein, which is a key landmark for identifying the location of the great vessels, the pericardium can be opened to identify the aortic root. Tracing the ascending aorta as it leaves the heart safely identifies the great vessels. If needed, the left innominate vein can be retracted or ligated (B) to improve exposure of the innominate artery and carotid arteries, which can be controlled proximally by placing clamps at their origins (C). Control of these vessels beyond the injury may be possible through the median sternotomy, or may require an additional incision (not shown: right cervical extension of the median sternotomy, supraclavicular subclavian artery exposure, infraclavicular subclavian artery exposure). Once proximal and distal control are achieved, the vessel can be debrided and repaired. Primary repair (suture closure) or a patch angioplasty can be used if the injury is not extensive (not shown). If the damage is more significant, an interposition graft (D) or bypass graft (E) may be necessary.