Delayed treatment of contained blunt traumatic aortic rupture: a case of rupture treated by endoprosthesis

Abstract

A 45-year-old man sustained an intracerebral frontal hematoma and a contained aortic isthmic rupture in a head-on automobile collision. Due to the intracerebral hemorrhage, open repair was contraindicated. Treatment with a stent graft was selected but delayed until the next morning, because the correct stent size was unavailable. Two hours before the time scheduled for surgery, the patient experienced oxygenation problems and became hypotensive. Chest radiography revealed a new, severe left hemothorax. Fortunately, the stent graft had just arrived from the manufacturer, and it was deployed to seal the ruptured aorta. Immediate angiography showed good stent-graft position without any endoleak as did a computed tomographic scan 2 days after the procedure. The patient was transferred to a rehabilitation unit to recover from his neurologic trauma. A 3-month follow-up computed tomographic scan showed the patient's condition to be unchanged.

Fig. 1 Chest computed tomographic scan (A and B) shows the ruptured aortic isthmus.

Fig. 2 Aortogram confirms the ruptured aortic isthmus.

Fig. 3 Chest radiograph shows a new large left hemothorax.

Fig. 4 Postprocedure aortogram shows good endoprosthesis position and absence of endoleak.

Fig. 5 Computed tomographic scan (A and B) immediately after stent-graft placement confirms stent position and absence of any endoleak.