title: Chronic False Aneurysm after a Healed Rupture of the Aortic Isthmus: TEVAR, Hybrid Surgery, or Open Arch Repair?
abstract: We report a case of post-traumatic chronic false aneurysm of the aortic isthmus in a 34-year-old man who had been involved in a car accident 10 years earlier. An initial chest X-ray demonstrated a calcified mass in the upper mediastinum and computed tomography scan revealed a false aneurysm of the aortic isthmus arising above the left subclavian artery. Partial covered rupture of the aorta is not always easy to diagnose and can remain clinically silent in a polytrauma patient. The duration from rupture to false aneurysm formation may extend over many years. This chronic lesion can be managed by surgery, by an endovascular procedure, or by a combined procedure. This case report highlights the current therapeutic approach. A debranching procedure was done in view of a secondary exclusion of the huge false aneurysm by a stent graft. Unfortunately, the false aneurysm ruptured during the procedure and a replacement of the aortic arch and the isthmus under total circulatory arrest was successfully done. The patient was doing well at 9-month follow-up.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium. Electronic address: cnizet@student.ulg.ac.be.
authors.forename: Christophe
authors.initials: C
authors.lastname: Nizet
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Van Damme
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Boesmans
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Lavigne
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium.
authors.forename: Etienne
authors.initials: E
authors.lastname: Creemers
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium.
authors.forename: Jean-Olivier
authors.initials: JO
authors.lastname: Defraigne
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D002908:Chronic Disease; D057510:Endovascular Procedures / Q000295:instrumentation; D006801:Humans; D008297:Male; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D014945:Wound Healing