Endovascular treatment of distal thoracic aortic transection associated with severe thoracolumbar spinal fracture

Abstract

Endovascular repair has become the first line of treatment in most patients with blunt aortic injury. The most common mechanism is deceleration injury affecting the aortic isthmus distal to the origin of the left subclavian artery. Injuries of the distal thoracic aorta are uncommon. We report the case of a 25-year-old male patient who presented with paraplegia and distal thoracic aortic pseudoaneurysm associated with severe thoracolumbar vertebral fracture and displacement after a motocross accident. Endovascular repair was performed using total percutaneous technique and conformable C-TAG thoracic stent-graft (WL Gore, Flagstaff, AZ). Following stent-graft placement and angiographic confirmation of absence of endoleak, thoracolumbar spinal fixation was performed in the same operative procedure. This case illustrates a multispecialty approach to complex aortic and vertebral injury and the high conformability of newer thoracic stent-grafts to adapt to tortuous anatomy.

Unstable thoracic spine fracture with aortic encroachment: A potentially fatal association and a suggested treatment

“…TAR is a leading cause of death with up to 85% pre-hospital mortality [1] , [2] , [3] . Among hospitalized patients one can observe an association between aortic lesions and unstable spinal fractures requiring surgery.…”

“…Traumatic aortic rupture (TAR) is often fatal (up to 85% pre-hospital mortality) with the thoracic descending segment most frequently affected [1] , [2] , [3] . In hospitalized patients one can observe an association between spinal fractures and aortic lesions [4] , [5] .…”

“…While several papers describe the occurrence and treatment of aortic lesions secondary to spinal surgery [7] , [8] , [9] , [10] , [11] there are few reports focusing on the management of unstable vertebral column fractures with a concomitant or potential aortic injury [3] , [6] , [12] , [13] , [14] . Such cases pose a real therapeutic dilemma as to the optimal timing for treatment, the priorities to be assigned and the most adequate procedures to be adopted.…”

“…The decision-making process requires a close multidisciplinary cooperation between spine/vascular surgeons and interventional radiologists with proper consideration given to individual cases [6] , [7] , [9] , [10] . The actual or potential vascular lesion takes absolute precedence [3] , [6] , [7] , [12] , [14] . Open, direct surgical repair (via thoracotomy) and endovascular treatment are alternative options followed by surgical reduction of the fracture.…”

“…Open, direct surgical repair (via thoracotomy) and endovascular treatment are alternative options followed by surgical reduction of the fracture. There are no clear guidelines as to the best therapeutic choice [6] , [10] , [13] although endovascular treatment has gained widespread use in recent years [1] , [2] , [3] , [8] , [10] . The decision should be made balancing the risks of each procedure versus the clinical condition of the patient to be treated.…”