Brachiocephalic artery injury repair

The rupture of the aortic arch and its branches can occur in penetrating injuries and can also be seen in blunt trauma to the chest. The right innominate artery is most common in blunt trauma, and the blunt injury of the left common carotid artery is rare. The anatomy of the aortic arch is shown in the figure below. Curing disease: Indication When the suspected innominate artery ruptures and hemorrhage, it is necessary to hurry for surgical exploration. Sometimes, even in the case of massive bleeding, or even sudden cardiac arrest, there are cases of surviving cases of surgical rescue. Surgery is the only treatment option for this type of casualty. Preoperative preparation 1. Strengthen anti-shock treatment, with adequate blood supply and autologous blood transfusion preparation. 2. Pay attention to check whether there is a combined brain, spine and abdominal organ injury and deal with it accordingly. Surgical procedure 1. The midline incision of the chest is extended to the injured neck, and the aortic arch and its branches can be exposed through the combined incision of the thoracic neck. 2. Cut the happy bag longitudinally and reveal the unknown artery from the pericardium. 3. Expose the front of the aortic arch, pay attention to protect the left unnamed vein, and first release it, and take it to the top with a rope. 4. If there is active bleeding in the root of the innominate artery, try to use the side wall clamp to block the aortic wall below the root of the innominate artery and temporarily control the bleeding. 5. The right subclavian artery and the right common carotid artery can be separated at the distal end, each of which is wound around a blocking band for the control of distal bleeding. (1) direct suture repair of the innominate artery rupture: blocking the root of the innominate artery without cerebral ischemic signs, can directly suture the laceration after the distal end of the innominate artery is blocked; otherwise, it can be placed between the ascending aorta and the distal carotid artery. Temporary artificial vascular bridge for shunting. The proximal and distal blood flow of the innominate artery was blocked, the hematoma in the injured area was cut and cleaned, and the wound of the innominate artery was examined for debridement and repair. The vascular tissue is free of defects and can be directly sutured and repaired. (2) Artificial blood vessel transplantation: If there is a defect in the wall of the innominate artery, the vascular grafting operation can be performed under the Gott shunt. The side wall of the ascending aorta and the distal branch of the innominate artery are clamped by the side wall clamp respectively, and the name is broken at the crack. The arteries were sutured separately. 8mm artificial blood vessels are generally used, and 5-0 polypropylene sutures are used to perform end-to-side anastomosis with the distal side. Then use the non-invasive side wall clamp to partially clamp the ascending aorta, make an incision in the anterior wall of the ascending aorta, make the end-to-side anastomosis between the proximal end of the artificial blood vessel and the ascending aorta, and vent the last needle when ligating. catheter. No active bleeding was detected and the artificial blood vessel transplant was completed. When combined with tracheal or esophageal injury, after repair, the pectoralis major or sternocleidomastoid muscle flap should be transplanted between the repaired blood vessels and the damaged trachea and esophageal injury, and the anti-infective treatment should be strengthened. complication After the innominate artery block, the incidence of cerebral ischemia combined with limb paralysis is about 25%. In addition to taking precautionary measures during surgery, postoperative monitoring and control of hyperthermia and hypoxia should be strengthened.

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