Posterior injury of the brachiocephalic trunk following gunshot thoracic trauma: Case report and literature review

Abstract

We present the case of a 23-year-old man who was admitted to the emergency department due to thoracic trauma with a gunshot wound in the right fifth intercostal space with the anterior axillary line, with an outflow tract in the third intercostal space on the left parasternal line. The patient exhibited signs of cardiac tamponade and grade IV hemorrhagic shock. Bilateral tube thoracostomy was performed, yielding a substantial left hemothorax (1500 mL). As the patient presented deterioration of hemodynamic instability despite adequate resuscitation maneuvers, prompted immediate transportation to the operating room to perform a sternotomy. A posterior brachiocephalic trunk injury was identified, consisting of a laceration of 60% of total circumference, with an extension of over 2 cm. The distal portion of the injury was resected and reconstructed using a 6 mm polytetrafluoroethylene graft, with a proximal graft anastomosis employing a lateral anchor technique and a distal graft anastomosis using a parachute technique, secured with 4-0 polypropylene vascular sutures. The patient's postoperative recovery progressed favorably, he remained in the intensive care unit for 5 days and in general hospitalization for an additional 4 days. Further interventions were not required. A control CT angiography was performed 3 months postoperatively, demonstrating complete graft patency.