Endovascular treatment of a blunt aortic injury in Iraq: extension of innovative endovascular capabilities to the modern battlefield.
BACKGROUND
The management of blunt descending thoracic aortic injury remains controversial. Despite emerging evidence touting the advantage of endovascular repair in civilian trauma, there have been no reports on the application of this management strategy in the austere environment of war. We provide a case report from the 332nd EMDG/Air Force Theater Hospital, Balad Air Base, Iraq.


METHODS
An Iraqi policeman presented with traumatic aortic disruption following blunt trauma. The patient arrived with hemoperitoneum, a Le Fort III facial fracture, a left humerus fracture, and a thoracic aortic disruption. Following facial packing, fracture stabilization, and damage control laparotomy, aortography was performed, confirming aortic disruption beyond the left subclavian artery. The injury was treated with three aortic cuffs (Gore Excluder AAA Aortic Extender Endoprostheses) placed in sequence from the origin of the left subclavian across the disruption. A type III endoleak was successfully managed with placement of one additional aortic cuff.


RESULTS
The patient was discharged after 1 month following the successful treatment of his other injuries. Computed tomography angiography at 10 and 30 days following the procedure revealed no endoleak and a resolved periaortic hematoma.


CONCLUSIONS
This report details the first endovascular treatment of blunt aortic injury in wartime and represents a sustained commitment to advance innovative endovascular capability closer to the time of injury. Although controversial, this less invasive approach is appealing in patients with high injury severity scores, making its availability in wartime especially germane.
Propper
Brandon W
BW
Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, TX 78236, USA. bpropper@me.com
Alley
Joshua B
JB
Gifford
Shaun M
SM
Burkhardt
Gabriel E
GE
Rasmussen
Todd E
TE
D000063:Accidents, Traffic; D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D004059:Diffusion of Innovation; D005147:Facial Bones / Q000293:injuries; D006406:Hematoma / Q000209:etiology / Q000601:surgery; D006465:Hemoperitoneum / Q000209:etiology / Q000601:surgery; D006801:Humans; D006810:Humeral Fractures / Q000209:etiology; D054542:Iraq War, 2003-2011; D008297:Male; D008887:Military Medicine; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*