Blunt Thoracic Aortic Injury in Case of a 15-Year-Old Boy: Difficulties and Possibilities of the Endovascular Approach

Alexander Gombert, Mohammad Esmaeil Barbati, Jochen Grommes, Houman Jalaie, Karina Schleimer, Michael J Jacobs, Johannes Kalder
Annals of Vascular Surgery 2016, 33: 228.e15-9

BACKGROUND: Blunt thoracic aortic injuries (BTAIs) are rare but life threatening. Most BTAI are caused by high-energy trauma. Among children with blunt trauma, the incidence of BTAI is below 1 percent. The present case deals with covered thoracic aortic rupture of a 15-year-old boy. Emphasizing the value and the difficulties of endovascular surgery in children is the motivation for this case report.

CASE REPORT: We are presenting the case of a 15-year-old boy, who suffered multiple traumata after accident. Beneath multiple fractures and a liver laceration, a thoracic aortic rupture with pseudoaneurysm of the aortic wall was diagnosed. Owing to the comorbidities, an endovascular therapy in combination with a transposition of the left subclavian artery to the common carotid artery was performed. The chronological line-up of the events and the endovascular treatment as well as the in-hospital follow-up are described.

DISCUSSION: Injury-induced BTAI in pubescent children rarely occurs. Only few cases can be found in literature, none of which were associated with the presented pattern of injury.

CONCLUSIONS: The optimal treatment for childhood BTAI is a case-by-case decision. We critically discuss the value of endovascular therapy in the present case.

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