Thoracic endovascular aortic repair (TEVAR) in a combined penetrating thoracic aortic and spinal cord injury

Abstract

Endovascular repair of aortic injuries secondary to blunt trauma has been widely described. However, literature on endovascular management in penetrating aortic injuries is scarce. The patient in this case report, a victim of penetrating thoracic aortic trauma, presented 5 days after injury with Brown-Sequard syndrome and a contained aortic injury (pseudoaneurysm) and was haemodynamically stable. Therefore, thoracic endovascular aortic repair was an option in this case. Endovascular repair carries a lower peri-operative morbidity and mortality rate than open repair. However, because most cases of penetrating thoracic vascular injury have haemodynamic instability, open surgery is considered the standard of care. This case demonstrates successful management of an aortic injury with a minimally invasive procedure.

Keywords: Brown–Sequard syndrome; aortic pseudoaneurysm; case report; penetrating injury; thoracic aortic injury; thoracic endovascular aortic repair.

Figure 1

(a) Sagittal STIR MR shows a hyperintense signal along the dorsal mid-thoracic soft tissue wound tract, extending into the spinal canal with T5 level cord disruption and T5 vertebral body marrow oedema. (b) Sagittal T2WI MR demonstrates cord oedema as a hyperintense signal of the central cord (T3 to T6 level).

Figure 2

(a) Axial T2WI MR at the midthoracic level demonstrates an epidural hematoma in the right lateral spinal canal with compression of the cord (arrow) and bilateral hydrothoraces (*). (b) Axial T2WI MR shows a round lesion (arrow) inseparable from the medial aspect of the mid-thoracic aorta (A), with an isointense signal to the thoracic aorta.

Figure 3

CT angiogram of the chest confirms a pseudoaneurysm (arrow) of the thoracic aorta (A), with surrounding mediastinal haematoma and bilateral haemothoraces.