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35
Vol. 18, No. 1 pp. 35–39
Copyright © 2012 Via Medica
ISSN 1234–950X
www.angiologia.pl
CASE REPORT
Blunt injury of descending thoracic aorta
— complicated but successful endovascular treatment
Andres Idla
1
, Tiit Kivistik
1
, Kalle Põder
2
, Vladislav Malikov
2
, Raivo Annus
1
, Andres Pulges
1, 3
,
Priit Põder
1, 3
1
Unit of Vascular Surgery, North Estonian Medical Centre, Tallinn, Estonia
2
Department of Angiology, North Estonian Medical Centre, Tallinn, Estonia
3
Cardiac Unit, University of Tartu, Estonia
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.
Key words: blunt trauma of thoracic aorta, endovascular treatment, endograft collapse
Acta Angiol 2012, 18, 1: 35–39
Address for correspondence
Priit Põder MD, PhD
North-Estonian Medical Centre, Estonia
Sütiste Street 19; 13419 Tallinn, Estonia
Phone: +37253319032
e-mail: priit.poder@gmail.com
Introduction
The first successful case of endovascular repair of the
thoracic aorta (TEVAR) was published in 1994 by Dake
et al. [1] and the first successful TEVAR for the thoracic
traumatic aortic rupture in 1997 by Semba et al. [2].
According to the literature, there is an increasing ten-
dency to use TEVAR as a treatment for blunt traumatic
aortic injuries [3]. Especially in young trauma patients
the specific anatomical features (like small diameter of
the aorta, serve angulation of the aortic isthmus) and
off-label usage of endografts are the main reasons for
the collapse of endoprosthesis [4].
In this paper we describe an interesting endo-
vascular treatment of the traumatic aorta including
a short discussion. Despite the fact that the TEVAR
was complicated due to type I endoleak and the late
collapse of the endograft, the reintervention has been
successful.
Case report
A 25-year-old male patient had multiple system
trauma caused by a traffic accident. Splenectomy and
suturing of the liver and fixation of the right femoral
bone was performed promptly after admission in the