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Case Reports
. 2017 Nov 29;12(1):106.
doi: 10.1186/s13019-017-0667-4.

Open stent graft repair with upper-half Sternotomy for blunt thoracic aortic injury: a case report

Toshinori Komatsu  1 , Tamaki Takano  2 , Hiromu Kehara  1 , Megumi Fuke  1 , Takamitsu Terasaki  1 , Masayuki Sakaguchi  1
Affiliations
Case Reports

Open stent graft repair with upper-half Sternotomy for blunt thoracic aortic injury: a case report

Toshinori Komatsu et al. J Cardiothorac Surg. .

Abstract

Background: Thoracic endovascular aortic repair is now widely applied to the treatment of blunt aortic injury. However, its long-term outcomes remain unclear. Endoleakage and migration might occur in the long term, especially when younger patients undergo endovascular aortic repair. In open stent grafting, the proximal end of the open stent graft is directly sutured to the native aorta, which may reduce the risk of endoleakage and migration. We applied open stent grafting to the treatment of blunt aortic injury in the subacute phase and herein report the patient's clinical course.

Case presentation: A 20-year-old man with a developmental disorder collided with a steel tower while skiing. He was transferred to our hospital by helicopter. X-ray examination and computed tomography revealed fractures of left humeral head and femoral neck and aortic isthmus dissection. We did not perform an acute-phase operation because of the presence of multiple trauma and instead performed open stent grafting with an upper-half sternotomy 42 days after the injury. He recovered uneventfully without psychological problems other than his preexisting developmental disorder. No endoleakage or aneurysm was observed during an 18-month follow-up period.

Conclusions: Open stent grafting might be an alternative to open surgery and thoracic endovascular aortic repair for blunt chest trauma, although intensive follow-up is needed.

Keywords: Aortic dissection; Blunt thoracic aortic injury; Multiple trauma; Open stent graft; Thoracic endovascular aortic repair.

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Conflict of interest statement

Ethics approval and consent to participate

The patient has provided permission to publish these features of his case, and the identity of the patient has been protected.

Consent for publication

Written consent was obtained from the patient before starting preparation for the manuscript.

Competing interests

All the authors have read the manuscript and have approved of its submission. The authors report no conflicts of interest.

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Figures

Fig. 1
Fig. 1
Chest X-ray showed a wide mediastinum, enlarged aortic knob, rightward deviation of the nasogastric tube, and a smudgy aortopulmonary window
Fig. 2
Fig. 2
Preoperative contrast-enhanced computed tomography. a Horizontal dislocation. b Sagittal section. The arrowhead shows dissection in zones 3 to 4 of the thoracic aorta
Fig. 3
Fig. 3
Schematic drawing of our open stent procedure
Fig. 4
Fig. 4
Postoperative contrast-enhanced computed tomography. a Horizontal dislocation. b Sagittal section. c Three-dimensional computed tomography. The arrowhead shows the stent graft
Fig. 5
Fig. 5
Surgical wound 43 days after the open stent grafting with upper-half sternotomy
See this image and copyright information in PMC

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