Endovascular Repair of a Traumatic Infrarenal Aortic Transection

Abstract

Blunt abdominal aortic trauma occurs in up to 0.04% of all nonpenetrating traumas. Although uncommon, mortality from this injury ranges from 18% to 37%. Seat belt injury is associated with almost 50% of reported blunt abdominal aortic traumas. The authors present the case of a 21-year-old man, a restrained passenger who was involved in a high-speed motor vehicle accident. In the emergency room, he had obvious evidence of lap-belt injury. His peripheral pulses were normal and there was no pulsatile abdominal mass. Computer tomography (CT) revealed a large amount of free intraperitoneal fluid throughout with signs of mesenteric avulsion and fracture/dislocation of T11-T12. The patient underwent an exploratory laparotomy. Right hemicolectomy and resection of small bowel was performed. CT angiography revealed an aortic transection and surrounding pseudoaneurysm 2 cm above the aortic bifurcation. The patient returned to the operating room for endovascular repair. Via a right femoral cutdown, a 14 mm x 5.5 cm stent-graft was placed across the distal abdominal aorta. Followup arteriogram revealed complete obliteration of the pseudoaneurysm without evidence of leak. There were no complications related to the aortic stent-graft in the postoperative period. The patient was discharged in good condition. As this case demonstrates, endovascular repair of traumatic aortic injury is feasible and may represent an improved treatment in certain settings.

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References

1. Parmley LF , Mattingly TW , Manion WC , et al: Nonpenetrating traumatic injury of the aorta. Circulation,17:1086-1101, 1958.

2. Roth SM , Wheeler JR , Gregory RT , et al: Blunt injury of the abdominal aorta: A review. J Trauma 42:748-755, 1997.

3. Lock JS , Huffman AD , Johnson RC : Blunt trauma to the abdominal aorta. J Trauma 27:674-677, 1987.

4. Randhawa MPS , Menzoian JO : Seat belt aorta. Ann Vasc Surg 4:370-377, 1990.

5. Naude GP , Back M , Perry MO , et al: Blunt disruption of the abdominal aorta: Report of a case and review of the literature. J Vasc Surg 931-935, 1997.

6. Lassonde J , Laurendeau F : Blunt injury of the abdominal aorta. Ann Surg 194:745-748, 1981.

7. Lindblad B , Brunkwall J , Lindh M , et al: Traumatic aortic rupture and retroperitoneal haematomatreatment including combined operative and endovascular approach. Eur J Vasc Endovasc Surg 17:451-455, 1999.

8. Marin ML , Veith FJ , Panetta TF , et al: Transluminally placed endovascular stented graft repair for arterial trauma. J Vasc Surg 20:466-473, 1994.

9. Maleux G , Soula P , Otal P , et al: Traumatic aortobiiliac dissection treated by kissing-stent placement. J Trauma 43:706-708, 1997.

10.

10. Marty-Ane C , Alric P , Prudhomme M , et al: Intravascular stenting of traumatic abdominal aortic dissection. J Vasc Surg 23:156-161, 1996.

11.

11. Vernhet H , Marty-Ane C , Lesnik A , et al: Dissection of the abdominal aorta in blunt trauma: Management by percutaneous stent placement. Cardiovasc Intervent Radiol 20:473-476, 1997.

12.

12. Picard E , Marty-Ane C , Vernhet H , et al: Endovascular management of traumatic infrarenal abdominal aortic dissection. Ann Vasc Surg 12:515-521, 1998.

13.

13. Ricen E , Dickens PF : Traumatic aneurysm of the aorta for 27 years duration. US Navy Med Bull 40:692-694, 1942.

14.

14. Campbell DK , Austin RF : Seat belt injury: Injury of the abdominal aorta. Radiology 92:123-124, 1969.

15.

15. Killen DA : Injury of the superior mesenteric vessels secondary to nonpenetrating abdominal trauma. Am Surg 30:306-312, 1964.

16.

16. Warrian RK , Shoenut JP , lannicello CM , et al: Seat belt injury to the abdominal aorta. J Trauma 28:1505-1507, 1988.

17.

17. Qureshi A , Roberts N , Nicholson A , et al: Three-dimensional reconstruction by spiral computed tomography to locate an aortic tear following blunt abdominal trauma. Eur J Vasc Endovasc Surg 14:316-317, 1997.

18.

18. Slomin SM , Nyman U , Semba CP , et al: Aortic dissection: Percutaneous management of ischemic complications with endovascular and balloon fenestration. J Vasc Surg 23:241-253, 1996.

19.

19. Peterson AH , Williams DM , Rodriguez JL , et al: Percutaneous treatment of a traumatic aortic dissection by balloon fenestration and stent placement. Am J Roentgenol 164:1274-1276, 1995.

20.

20. Parodi JC , Palmaz JC , Barone HD : Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5:491-499, 1991.

21.

21. Michaels AJ , Gerndt SJ , Taheri PA , et al: Blunt force injury of the abdominal aorta. J Trauma 41:105-109, 1996.