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Case Reports
. 2023 Jul 27:60:33-36.
doi: 10.1016/j.ejvsvf.2023.07.002. eCollection 2023.

Focal Aortic Dissection With Significant Stenosis: A Rare Long Term Complication After TEVAR for Blunt Traumatic Aortic Injury in an Adolescent Patient

Jelle A Nieuwstraten  1 , Randolph G Statius van Eps  1 , Jan J Wever  1 , Hugo T C Veger  1
Affiliations
Case Reports

Focal Aortic Dissection With Significant Stenosis: A Rare Long Term Complication After TEVAR for Blunt Traumatic Aortic Injury in an Adolescent Patient

Jelle A Nieuwstraten et al. EJVES Vasc Forum. .

Abstract

Background: Thoracic endovascular aortic repair (TEVAR) in children and adolescents after blunt traumatic aortic injury (BTAI) is being performed increasingly despite no endovascular graft being approved for TEVAR in this population. The smaller diameter of the aorta and access vessels and steeper angle of the aortic arch pose specific challenges for TEVAR in this population. Moreover, data are lacking regarding medium to long term complications. This case presents an adolescent patient who underwent TEVAR for BTAI and suffered a focal aortic dissection several months later.

Report: The patient initially presented after a motor vehicle accident and underwent an uncomplicated TEVAR procedure with a 28 mm diameter stent graft (the smallest device available at the time) for Grade III traumatic aortic dissection; the native aortic diameter was 15 mm. The diameter mismatch was accepted due to the lifesaving nature of the procedure. More than 7 months later the patient presented to the emergency department after not being able to urinate for several days and experiencing pain, tingling, and weakness in both legs. Blood samples showed a severe acute kidney injury and computed tomography angiography showed significant aortic stenosis in the distal part of the stent graft, probably caused by a focal dissection. The stenosis and dissection were successfully treated using a Palmaz stent, after which his renal function and extremity complaints recovered.

Conclusion: The focal dissection was probably caused by stress on the aortic wall due to the aorta-stent graft diameter mismatch. This case demonstrates that complications after TEVAR in adolescents can arise months after the initial procedure and underscores the need for continued vigilance, especially in cases with an aorta-stent graft mismatch. The threshold for additional imaging and consultation by a vascular surgeon should be low.

Keywords: Adolescent; Aortic stenosis; Blunt traumatic aortic injury; Paediatric; TEVAR.

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Figures

Figure 1
Figure 1
Computed tomography angiography images of traumatic thoracic aortic transection in a 17 year old male.
Figure 2
Figure 2
Computed tomography angiography images of aortic stenosis directly distal to the TEVAR graft.
Figure 3
Figure 3
Situation after placement of Palmaz stent.
See this image and copyright information in PMC

References

    1. Raulli S.J., Schneider A.B., Gallaher J., Motta F., Parodi E., Farber M.A., et al. Trends and outcomes in management of thoracic aortic injury in children, adolescent, and mature pediatric patients using data from the National Trauma Data Bank. Ann Vasc Surg. 2023;89:190–199. - PubMed
    1. Hasjim B.J., Grigorian A., Barrios C., Schubl S., Nahmias J., Gabriel V., et al. National trends of thoracic endovascular aortic repair versus open thoracic aortic repair in pediatric blunt thoracic aortic injury. Ann Vasc Surg. 2019;59:150–157. - PubMed
    1. Azizzadeh A., Keyhani K., Miller C.C., Coogan S.M., Safi H.J., Estrera A.L. Blunt traumatic aortic injury: initial experience with endovascular repair. J Vasc Surg. 2009;49:1403–1408. - PubMed
    1. Gunabushanam V., Mishra N., Calderin J., Glick R., Rosca M., Krishnasastry K. Endovascular stenting of blunt thoracic aortic injury in an 11-year-old. J Pediatr Surg. 2010;45 - PubMed
    1. Hiremath G., Morgan G., Kenny D., Batlivala S.P., Bartakian S. Balloon expandable covered stents as primary therapy for hemodynamically stable traumatic aortic injuries in children. Catheter Cardiovasc Interv. 2019;95:477–483. - PubMed

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