title: Endovascular repair of traumatic aortic injury using a modified, commercially available endograft to preserve aortic arch branches.
abstract: A 25-year-old woman was admitted to our hospital after being involved in a high-speed motorcycle accident. Computed tomography angiography revealed a blunt traumatic aortic injury of the lesser curvature of the distal aortic arch accompanied by splintered fractures of the seventh thoracic vertebra and left clavicle. If the pseudoaneurysm had been treated with open surgical repair, then arch replacement under cardiopulmonary bypass, which was considered to be too invasive, would have been necessary. Therefore, thoracic endovascular aortic repair (TEVAR) was preferred as a first-line treatment to prevent pulmonary complications and hemorrhaging. Because the proximal landing zone for TEVAR was insufficient, we used a modified (fenestrated) commercially available endograft to preserve the branches of the aortic arch. Postoperative computed tomography scans confirmed that the pseudoaneurysm had been excluded without the endoleaks, and the aortic arch branches were patent. The patient's postoperative course was uneventful, and she was discharged from the hospital to have surgery for a vertebral fracture on postoperative day 6.
authors.affiliation: Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. Electronic address: kawajiri@koto.kpu-m.ac.jp.
authors.forename: Hidetake
authors.initials: H
authors.lastname: Kawajiri
authors.affiliation: Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Oka
authors.affiliation: Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Sakai
authors.affiliation: Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Taiji
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kanda
authors.affiliation: Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yaku
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D017541:Aneurysm, False / Q000175:diagnosis / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000295:instrumentation*; D005260:Female; D006801:Humans; D009049:Motorcycles; D011474:Prosthesis Design; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000601:surgery*