Blunt injury of descending thoracic aorta — complicated but successful endovascular treatment

Abstract

We present a case-report of a young 25-year-old male patient with blunt thoracic aortic injury caused by a traffic accident. Additionally he had (as a multiple trauma patient) the contusion of both lungs, rupture of the spleen and the liver, long bone fractures, and a traumatic face injury. The patient was treated with repeated endograft replacement and a debranching operation of the common carotid arteries and left subclavian artery. After multiple trauma, a Gore TAG (26 × 100 mm) endograft was implanted because of traumatic transection of the aortic isthmus. On the second day minor proximal type I endoleak was noted by CT-angiography. Balloon-dilatation of the proximal part of the endograft was performed. On the 24th postoperative day the patient was referred to the rehabilitation centre. Three weeks later the patient had serve chest pain, and emergency CT-angiography revealed the collapse of the stent graft. On the first stage a debranching operation was performed between the common carotid arteries with supported ePTFE graft and transposition of the left common carotid artery to the left subclavian artery. Next, a COOK Zenith TX2 endograft (32 × 200 mm) was placed proximal to the aortic arch covering the left common carotid artery. Recovery was uneventful and one year after the trauma no endoleak has been detected.

Acta Angiol 2012, 18, 1: 35–39