Emergency endovascular management of a post-traumatic pseudoaneurysm of the aortic isthmus: A case report

Abstract

Blunt thoracic aortic trauma is a rare but life-threatening emergency, ranking as the second leading cause of traumatic death after head injuries. The aortic isthmus is the most commonly affected site. The advent of endovascular techniques has significantly improved the management of these injuries. We report a case of a post-traumatic pseudoaneurysm of the aortic isthmus successfully treated with emergency thoracic endovascular aortic repair (TEVAR). We describe the case of a 31-year-old man admitted to the emergency department after a high-speed motor vehicle collision. CT angiography revealed a pseudoaneurysm of the aortic isthmus, associated with a small hemopericardium and moderate bilateral hemothorax. In the absence of associated visceral injuries requiring prior surgical intervention, a multidisciplinary team opted for urgent endovascular exclusion of the lesion. A thoracic endoprosthesis was successfully deployed in the catheterization suite. Intraoperative imaging confirmed complete exclusion of the pseudoaneurysm with no endoleak. The postoperative course was uneventful, and the patient was discharged on day five. TEVAR is now recommended as the first-line treatment for stable patients with blunt aortic injury. Compared to open surgery, it is associated with significantly lower perioperative morbidity and mortality. This case illustrates the feasibility, safety, and efficacy of TEVAR in an emergency setting. TEVAR is a safe and effective therapeutic alternative for traumatic lesions of the aortic isthmus, provided there is rapid diagnosis, multidisciplinary coordination, and an appropriate technical platform.