Traumatic Innominate Artery Pseudoaneurysm in the Setting of a Bovine Arch

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Blunt traumatic injury of the innominate artery occurs infrequently but is commonly lethal. Bovine aortic arch anatomy is a predisposition to this injury. Clinical findings, chest X-ray, and computerized tomography may suggest the diagnosis, and it may be confirmed with angiography. Both interposition and bypass grafting are operative repair methods of choice. EEG monitoring confirms cerebral perfusion, thereby allowing the deferment of shunts and cardiovascular bypass with hypothermic arrest. We report a case of traumatic innominate artery pseudoaneurysm in the setting of “bovine aortic arch” anatomy, together with multiple associated injuries, including descending aorta transection. We also review the current literature on the topic.