Endovascular Repair of Traumatic Aortic Pseudoaneurysm With Associated Celiacomesenteric Trunk

Abstract

To report stent-graft repair of a traumatic aortic pseudoaneurysm in proximity to a celiacomesenteric trunk. An 18-year-old woman suffered a large gunshot wound to the right flank. At laparotomy, only a large, nonexpanding right retroperitoneal hematoma was found, which was thought to represent significant penetrating trauma to the kidney mass. The patient was monitored in the intensive care unit. One week later, computed tomography revealed a partially infarcted right kidney and a 2.3-cm supraceliac aortic pseudoaneurysm, with adjacent bullet fragments. An angiogram confirmed the pseudoaneurysm and showed it to be 7 mm from the celiacomesenteric trunk. Endovascular repair was undertaken with a 16 x 55-mm AneuRx stent-graft, which was successfully placed across the aortic pseudoaneurysm without covering the celiacomesenteric trunk. Imaging at 12 months revealed no endoleak and full pseudoaneurysm exclusion. This operative approach is appropriate for the individual patient who has suitable anatomy and a clinical course that requires immediate repair of an aortic injury to prevent further complications and delays in ancillary treatments.