DIAGNOSTIC CIRCUMSTANCES: Non-iatrogenic traumas of the brachiocephalic arterial trunk (BCAT) are rare. Open traumas predominate and involve the distal half of the artery. Closed traumas are secondary to violent injury with severe deceleration and involve the proximal part of the artery. This diagnosis must be systematically evoked in patients with violent traumas or exhibiting wounds of the thorax and/or base of the neck. Emergency thoracic radiography usually reveals a widening of the mediastinum and a subsequent arteriography is essential for the surgeon. Concomitant lesions are frequent; which complicate diagnosis, prognosis and therapeutic management.
Surgical treatment: The approach of choice is cervico-sternotomy. For lesions secondary to an open trauma, direct repair is the usual approach. Treatment of disinsertions, secondary to a closed trauma, requires by-pass between the ascending aorta and the distal part of the BCAT and lateral suture of the aortic cross. POOR PROGNOSIS: However, mortality has decreased over the past 30 years due to the advances in medical imaging and improved medical-surgical management in specialized emergency centres. FISTULAS BETWEEN THE TRACHEA AND THE BCAT: Dramatically complicate tracheotomy. Their diagnosis is usually easy and relies on rigid bronchoscopy in the absence of severe hemorrhage. Treatment is above all preventive. Curative treatment is always urgent and consists in binding the BCAT. Prognosis is poor and often worsened by the underlying pathology.