title: Endovascular treatment of distal thoracic aortic transection associated with severe thoracolumbar spinal fracture.
abstract: Endovascular repair has become the first line of treatment in most patients with blunt aortic injury. The most common mechanism is deceleration injury affecting the aortic isthmus distal to the origin of the left subclavian artery. Injuries of the distal thoracic aorta are uncommon. We report the case of a 25-year-old male patient who presented with paraplegia and distal thoracic aortic pseudoaneurysm associated with severe thoracolumbar vertebral fracture and displacement after a motocross accident. Endovascular repair was performed using total percutaneous technique and conformable C-TAG thoracic stent-graft (WL Gore, Flagstaff, AZ). Following stent-graft placement and angiographic confirmation of absence of endoleak, thoracolumbar spinal fixation was performed in the same operative procedure. This case illustrates a multispecialty approach to complex aortic and vertebral injury and the high conformability of newer thoracic stent-grafts to adapt to tortuous anatomy.
authors.affiliation: Mayo Medical School, Mayo Clinic, USA.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Chock
authors.affiliation: Department of Surgery, Mayo Clinic, USA.
authors.forename: Johnathon
authors.initials: J
authors.lastname: Aho
authors.affiliation: Department of Surgery, Mayo Clinic, USA.
authors.forename: Nimesh
authors.initials: N
authors.lastname: Naik
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Clarke
authors.affiliation: Department of Surgery, Mayo Clinic, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Heller
authors.affiliation: Department of Surgery, Mayo Clinic, USA oderich.gustavo@mayo.edu.
authors.forename: Gustavo S
authors.initials: GS
authors.lastname: Oderich
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D057510:Endovascular Procedures / Q000295:instrumentation; D005592:Fracture Fixation; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D009049:Motorcycles; D011474:Prosthesis Design; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D015607:Stents; D013904:Thoracic Vertebrae / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*
keywords: Endovascular repair; aorta; blunt trauma; thoracolumbar fracture