Blunt innominate artery injury

Traumatic injury to the innominate artery is a rare occurrence. A literatur e review reveals that penetrating wounds account for the overwhelming major ity of these injuries. Fewer than 90 cases of innominate artery injury caus ed by blunt trauma have been documented. Over the past 12 months the trauma service successfully treated two patients with blunt injury to the innomin ate artery. Both cases involved high-speed motor vehicle crashes with sudde n deceleration. Both patients were wearing lap and shoulder restraints and had similar associated bruising following the line of the shoulder harness. The first patient presented with a wide mediastinum on chest X-ray. Angiog raphy revealed an innominate artery injury at the aortic arch. The second p atient had a normal chest X-ray. Given the extent of soft tissue bruising f rom the shoulder harness he underwent a magnetic resonance angiography, whi ch was suspicious for an innominate artery injury. Arch aortography confirm ed a disruption of the innominate artery midway between its origin and its bifurcation. Both were repaired through a median sternotomy with cervical e xtension as necessary. Given the present technology of safety restraint dev ices this injury may occur with greater frequency. A "shoulder strap sign" should prompt a search for more extensive injuries.