Injury to the innominate artery may represent a Zone I cervical, thoracic outlet, or intrathoracic vascular injury and poses diagnostic, exposure, and management problems for the general, vascular and thoracic surgeon. This complex injury becomes a new learning experience with each infrequent encounter. Here presented is a young woman who sustained a thoracic gunshot wound, producing innominate artery injury with AV fistulae. The method of repair is graphically illustrated, utilizing the bypass principle, with a synthetic conduit, and without use of systemic heparinization or complex temporary shunt.