SURGICAL-MANAGEMENT OF PENETRATING MEDIASTINAL ARTERIAL TRAUMA

Fifty-two patients with penetrating injury to the arteries caudal to t he thoracic inlet and cephalad to the heart came under the care of the Durban Metropolitan Vascular Service, South Africa, over a 13-year pe riod. The innominate artery was the commonest vessel injured (n=23). F ive patients (11%) had multiple vessel injuries, four of which involve d the aortic arch, and 18 (34%) had arteriovenous fistulae. Mortality was greatest with injuries involving the aortic arch (n=17) and ascend ing aorta (n=4) in which intra-operative exsanguination was the leadin g cause of death (five patients). Injuries involving the inferior and posterior walls of the aortic arch and those located between the innom inate and left common carotid origins were the most difficult to contr ol. Seven patients with aortic injuries presented with cardiac tampona de, three of whom had associated injuries involving the atria. Seven o f 21 (33%) patients with aortic injuries died compared to 2 of 31 (6%) with aortic arch branch injury (p<0.05, chi-square) for an overall mo rtality of 17%.