Transcarotid thoracic endovascular aortic repair for rupture of the aortic isthmus due to high energy blunt trauma: A case report

  • Ngo Tuan Anh 108 Military Central Hospital
  • Nguyen Quoc Hung 108 Military Central Hospital
  • Dao Huy Hieu 108 Military Central Hospital
  • Nguyen Tien Dong 108 Military Central Hospital
  • Tran Quang Thai 108 Military Central Hospital
  • Ha Hoai Nam 108 Military Central Hospital
  • Hoang Anh Tuan 108 Military Central Hospital
  • Dang Cong Hieu 108 Military Central Hospital
  • Dinh Tien Dung 108 Military Central Hospital
  • Nguyen Thi Thu Hien 108 Military Central Hospital
  • Nguyen Thi Thanh Kim Hue 108 Military Central Hospital
  • Luu Thi Mai Huong 108 Military Central Hospital
  • Nguyen Thi Kim Thuy 108 Military Central Hospital
  • Tran Manh Thang 108 Military Central Hospital

Main Article Content

Keywords

Thoracic endovascular aortic repair, blunt thoracic aortic injury (BTAI), aortic isthmus

Abstract

Introduction: Blunt thoracic aortic injury (BTAI) is associated with very high mortality, and managing currently favors thoracic endovascular aneurysm repair (TEVAR) if feasible, especially BTAI due to high energy force, where patients usually suffer from polytrauma, which requires rapid discover and treat spontaneously. However, a remarkable group of patients is contraindicated for the transfemoral route- the established first-line approach in endovascular interventions of the aorta. Here, we report a successful case in which the carotid artery was used to perform TEVAR. Case presentation: A young female was transferred to our emergency department after injuries sustained by falling from the fifth floor. Her vital signs were stable on admission. Pan CT scan revealed multiple injuries: A grade III injury of the aortic isthmus, a grade III liver injury without active bleeding, and fracture of the sternum, multiple ribs, T12-L1 vertebral body, and pelvic ring. However, her hemodynamics became unstable, and we decided to perform an urgent endovascular repair. During preparations for TEVAR, we found that the diameter at the proximal landing zone was 17.1mm, so it cannot be accommodated by any of the available thoracic endograft devices. Under the emergency condition, we decide to perform TEVAR by abdominal aortic device and access via the carotid to suit the device's length. After inpatient rehabilitation, she was discharged without neurologic sequelae. Conclusion: Transcarotid TEVAR is feasible and could be considered as an alternative approach in some specific patients with BTAI.

Article Details

References

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