Endoluminal therapy for Traumatic Aortic Transection

Presentation: A 24-year-old male was riding a motocross bike in the street, with no lights or helmet, and was struck broadside by another vehicle. The patient suffered multiple open long bone fractures. Standard Trauma life support was performed and the patient stabilized. Chest CT scan demonstrated an aortic dissection with a pseudo-aneurysm formation. There were no intra-abdominal or intra-cranial injuries. The patient underwent a thoracic endografting by the vascular service and stabilization of his musculoskeletal injuries by the orthopedic services.

Thoracic aortic endografting: The right common femoral artery was exposed and a 22 Fr introducer sheath deployed over an Amplatz stiff wire. Simultaneous cannulation and deployment of a 4 Fr pigtail catheter from the left axillary artery was performed. A thoracic arteriogram confirmed the CT diagnosis and established landmarks. A Gore 26mm x 10cm Thoracic endograft (TAG, WL Gore Ltd, Flagstaff, AZ) was deployed across a traumatic pseudo-aneuysm. There was no Type I or Type II endoleak. The left subclavian arterial origin remained intact. There were no complications.

Hospital Course: The patient tolerated the procedure well and remained in the trauma intensive care for 3 days. He returned to the operating room for interval orthopedic procedures during this time. He was subsequently transferred to a regular floor for 5 days prior to discharge to a rehabilitation facility. He was discharged home, is now mobile and has returned to work.

Serial CT scans of the chest show a stable Thoracic Endograft placement and resolution of the pseudoaneurysm with one year follow up.

		Figure 1 CTA 3D reconstruction A chest CT scan this 3D reconstruction shows a transected aorta at the distal aortic arch and proximal descending thoracic aorta. There is a large surrounding hematoma and pseudoaneurysm formation.
		Figure 2 Initial aortogram The arch of the aorta is is uninjured with a bovine configuration. The right innominate and subclavian are normal. The right common carotid artery is normal. The left common carotid artery is normal. The left subclavian artery (SCA) is normal. There is a pseudo-aneurysm (PA) in the area of the aortic transection 2 cm distal to the left subclavian artery.
		Figure 3 Final aortogram There has been interval placement of a Gore TAG thoracic endograft (TAG), which extends from the arch to the descending aorta. There is complete exclusion of the traumatic pseudoaneurysm (PA). There is no Type I or Type II endoleak and the origin of the left subclavian artery (SCA) remains intact.