Case Report Successfully Kissing Stent of Innominate Artery and Left Common Carotid Artery Subsequent to Blunt Injury, in the Setting of a Bovine Aortic Arch Pietro Volpe, 1 Giovanni De Caridi, 2 Raffaele Serra, 3,4 Antonino Alberti, 1 and Mafalda Massara, 1 Reggio Calabria, Italy, and Messina, Italy, and Catanzaro, Italy Blunt injuries of the great vessels arising from the aortic arch are usually fatal. The innominate artery lesions represent the most common site of injury after the aortic isthmus distal to the left subclavian artery. Injuries are usually located at the origin of the vessel from the aortic arch, especially in patients with bovine aortic arch. Open traditional repair is a successful but invasive treatment, with long hospital stay and different possible complications. Although a bovine aortic arch presents an increased technical challenge, it is possible to achieve a complete and safe repair of the innominate artery injuries through a total endovascular treatment, with important reduction of risks and complications related to operation, compared to traditional open repair. We report the case of a 62-year-old man in our hospital with a posttraumatic pseudoaneurysm of the innominate artery in the setting of a bovine aortic arch, associated with a transection of the descending thoracic aorta. In the urgent setting, the patient was submitted to a kissing stent of innominate arteryeleft common carotid artery and deployment of thoracic endoprosthesis to exclude the aortic transection, with good final result. Blunt injuries of the thoracic aorta or of the great vessels arising from the aortic arch are usually fatal. The most common site of disruption is the aortic isthmus distal to the left subclavian artery (LSA), but other sites include the ascending aorta, Innom- inate Artery (IA), left Common Carotid Artery (LCCA), and LSA. Approximately 75e90% of blunt thoracic aortic injuries result in immediate death. 1 The remaining patients require very often an urgent treatment. The Innominate Artery (IA) injury is an infre- quent, but life-threatening condition, due in the majority of cases, by penetrating trauma, yet 35% are attributed to blunt trauma. 2,3 Anatomically, in the 70% of population, IA, LSA, and LCCA originate from the aortic arch. An anatomical variant named ‘‘bovine aortic arch’’ Conflict of Interest: None. Funding: None. 1 Unit of Vascular and Endovascular Surgery, Grande Ospedale Met- ropolitano ‘‘Bianchi-Melacrino-Morelli’’, Reggio Calabria, Italy. 2 Department of Biomedical Sciences, University of Messina, Messina, Italy. 3 Department of Medical and Surgical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy. 4 Interuniversity Center of Phlebolymphology, International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy. Correspondence to: Prof. Raffaele Serra, MD, PhD, Department of Medical and Surgical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy; Interuniversity Center of Phlebolymphology, Interna- tional Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Viale Europa 88100 Catanzaro, Italy; E-mail: rserra@unicz.it Ann Vasc Surg 2019; -: 1.e1–1.e4 https://doi.org/10.1016/j.avsg.2019.10.047 Ó 2019 Elsevier Inc. All rights reserved. Manuscript received: September 13, 2019; manuscript accepted: October 1, 2019; published online: --- 1.e1