Exposure of arch branches for repair following trauma can be difficult. Seven patients with blunt injuries and 5 with penetrating injuries underwent repair of the innominate, common carotid and subclavian arteries. Common associated injuries included head injury, hemopneumothorax, lung contusion, long bone fractures and brachial plexus injury. Widened mediastinum was seen in 5 patients. Six patients with innominate, right subclavian and right common carotid injuries were approached through sternotomy with extension into the right side of the neck. Posterolateral thoracotomy was used to reach the proximal left subclavian artery in 2. Combined supra- and infraclavicular incision were utilized for the distal subclavian artery in 4. Eleven patients are alive, one to 7 years after surgery. One died of an unrelated cause. Head injuries complicated the postoperative management in 4 of the 7 patients with blunt trauma. Two patients with brachial plexus injury continued to have neurologic deficits. All arterial repairs have remained patent and there have been no graft infections.
Neurologic complications continue to plague aortocoronary bypass operations. All patients undergoing isolated coronary artery bypass procedures over a four-year period at the Upstate Medical Center were reviewed. Eight of 893 patients sustained a cerebrovascular accident following operation (0.9%). In 5 patients, the etiology was felt to be calcific and atherosclerotic debris from the ascending aorta. Air embolism occurred in one patient, and the etiology was unknown in 2 patients. Various methods to deal with the diffusely atherosclerotic aorta are discussed.
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