Endoluminal Stent Graft Repair of Traumatic Thoracic Aortic Pseudoaneurysm

Acute rupture of the thoracic aorta caused by blunt chest trauma is a life threatening injury accounting for up to 18% of deaths in motor vehicle accidents. The mechanism is attributed to the combination of sudden deceleration and the relative immobility of the thoracic aorta at the ligamentum arteriosum, the left subclavian artery and the intercostal arteries. Aortic disruptions occur just distal to the left subclavian artery in 97% of cases. Disruptions of the distal descending aorta are rare and occur less than 1% of the time. Death follows a bimodal distribution with most patients dying at the scene. However, approximately 15±20% of patients reach the hospital alive because of the preserved continuity of adventitia and mediastinal structures surrounding the injured aorta. Of those potentially curable patients, the overall mortality still remains as high as 30%. Covered stents have been selectively used in the treatment of chronic thoracic aneurysms and dissections but have only been anecdotally reported for the treatment of traumatic thoracic aortic pseudoaneurysms. We report a case of a patient with multisystem trauma with an unusual distal thoracic aortic injury treated successfully with endovascular grafting.