Transcarotid thoracic endovascular aortic repair for rupture of the aortic isthmus due to high energy blunt trauma: A case report

Abstract

Introduction: Blunt thoracic aortic injury (BTAI) is associated with very high mortality, and managing currently favors thoracic endovascular aneurysm repair (TEVAR) if feasible, especially BTAI due to high energy force, where patients usually suffer from polytrauma, which requires rapid discover and treat spontaneously. However, a remarkable group of patients is contraindicated for the transfemoral route- the established first-line approach in endovascular interventions of the aorta. Here, we report a successful case in which the carotid artery was used to perform TEVAR. Case presentation: A young female was transferred to our emergency department after injuries sustained by falling from the fifth floor. Her vital signs were stable on admission. Pan CT scan revealed multiple injuries: A grade III injury of the aortic isthmus, a grade III liver injury without active bleeding, and fracture of the sternum, multiple ribs, T12-L1 vertebral body, and pelvic ring. However, her hemodynamics became unstable, and we decided to perform an urgent endovascular repair. During preparations for TEVAR, we found that the diameter at the proximal landing zone was 17.1mm, so it cannot be accommodated by any of the available thoracic endograft devices. Under the emergency condition, we decide to perform TEVAR by abdominal aortic device and access via the carotid to suit the device's length. After inpatient rehabilitation, she was discharged without neurologic sequelae. Conclusion: Transcarotid TEVAR is feasible and could be considered as an alternative approach in some specific patients with BTAI.