This study retrospectively examines major vascular injuries that occurred during elective thoracic surgeries over a 10-year period at a single tertiary care center. Although these injuries are rare, they can lead to life-threatening complications. The study aims to determine how often these injuries happen, what causes them, and how they are managed during surgery. It also evaluates the role of preoperative imaging and planning, including cardiovascular surgery team involvement, in preventing or managing these events. The findings are intended to help improve surgical safety and guide future preventive strategies.

Inclusion Criteria:

• Patients who underwent elective thoracic surgery between January 2015 and December 2024
• Development of a major intraoperative vascular injury during surgery
• Injury involving central vessels such as the subclavian artery or vein, brachiocephalic vein, innominate artery or vein, superior vena cava (SVC), or thoracic aorta
• Availability of complete operative and postoperative medical records
• Underwent surgical repair of the vascular injury (e.g., grafting, primary repair, ligation)

Exclusion Criteria:

• Patients undergoing emergency thoracic surgery
• Injuries limited to pulmonary artery or its branches
• Minor bleeding from peripheral vessels that did not require major intervention
• Postoperative vascular complications (e.g., delayed hemorrhage, pseudoaneurysm)
• Missing or incomplete operative records

This study includes adult patients who underwent elective thoracic surgical procedures between January 2015 and December 2024 at a single tertiary care academic center. The study population is limited to patients who experienced major intraoperative vascular injuries involving central thoracic vessels such as the subclavian artery or vein, brachiocephalic vein, innominate artery or vein, superior vena cava (SVC), or thoracic aorta. All included patients required immediate surgical intervention for bleeding control. The study is retrospective and descriptive in nature.