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.