Endovascular Stent for Iatrogenic Penetrating Injury of the Thoracic Aorta

Abstract

Endovascular stent graft utilization of the thoracic aorta has increased the treatment scope for the management of emergent and elective aortic pathology. This is particularly useful in clinical scenarios deemed too high an open surgical risk secondary to significant comorbidities.

Thoracic Endovascular Aortic Repair for Iatrogenic Injury of the Thoracic Aorta

“…With improving endovascular devices, imaging techniques, and low morbidity and mortality, TEVAR has gained popularity as a first-line treatment option for many thoracic aortic pathologies. 4,14 In fact, some authors support thoracic endovascular repair (TEVAR) regardless of impingement or penetration. 8,10,13 TEVAR becomes particularly appealing in the absence of infection, 9 the elderly population, 8 and when the patient is not deemed a suitable candidate for thoracotomy.…”

“…8,10,13 TEVAR becomes particularly appealing in the absence of infection, 9 the elderly population, 8 and when the patient is not deemed a suitable candidate for thoracotomy. 3,4 Some limiting factors when considering TEVAR include pediatric patients due to smaller, growing anatomy and need for durable repair; patients with injury to branch vessels that may be better suited for open reconstruction; patients that require open extraction of foreign bodies; and patients with anatomy outside of device instructions for use. TEVAR was chosen in our patient to cover arteriotomies after screw removal, allow neurosurgery to continue their spinal revision without a subsequent return to the operating room, location of injury distant from any branch vessels, and the patient's preference to avoid a more morbid open repair.…”

“…1 Other procedures, such as thoracentesis, pacemaker placement, pericardiocentesis, and esophagoscopy, have also been implicated in aortic injury. [2][3][4][5] Various treatment approaches have been used for aortic repair in the setting of iatrogenic aortic injury: open aortic repair, hemostatic glue, observation, 6 and as in this case, TEVAR.…”

Thoracic stent graft placement for repair of iatrogenic aortic injury secondary to sheath placement during pacemaker insertion

“…An AneuRx aortic cuff stent graft (Medtronic, Santa Rosa, CA) was used successfully in this instance, and the patient remained complication free for 8 years of follow-up care as of 2014. 4 …”

Transaortic gunshot wound through perivisceral segment successfully managed by placement of thoracic stent graft

“…This use has been described for gunshot injury to the thoracic aorta as well as for iatrogenic injury. 2 , 3 The thoracoabdominal gunshot wound remains a substantial challenge that carries with it a markedly high morbidity and mortality. Novel approaches that provide rapid control of bleeding and repair of the injury in this anatomically critical region are desired.…”