Thoracic Branched Endograft for the Treatment of Blunt Thoracic Aortic Injury with Retroesophageal Aberrant Right Subclavian Artery
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0345
Submission Type:
Abstract Submission
Authors:
Adam Carroll (1), Donald Jacobs (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions:
(1) University of Colorado Anschutz, Denver, CO
Submitting Author:
Adam Carroll
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University of Colorado Anschutz
University of Colorado Anschutz
Co-Author(s):
Donald Jacobs
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University of Colorado Anschutz
University of Colorado Anschutz
*Muhammad Aftab
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University of Colorado Anschutz
University of Colorado Anschutz
*T. Brett Reece
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University of Colorado Anschutz
University of Colorado Anschutz
Presenting Author:
Adam Carroll
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University of Colorado Anschutz
University of Colorado Anschutz
Abstract:
Objective:
Endovascular repair has become the standard of treatment for blunt thoracic aortic injury (BTAI). Aberrant right subclavian artery (ARSCA) complicates treatment of BTAI, with described cases excluding the ARSCA with extra-anatomic bypass when indicated. We describe a novel case of using thoracic branched endograft (TBE) in a patient with an ARSCA presenting with BTAI.
Methods:
We discuss the case of a 38 year old female admitted to our institution after a high speed motor vehicle collision. The patient presented with numerous injuries including multiple cervical spine, rib, and extremity fractures, abdominal solid organ injury, as well as a grade 3 BTAI with ARSCA.
Results:
The above patient was discussed at aortic conference, special consideration was taken to the retroesophageal passage of the ARSCA, however, the associated mediastinal hematoma displaced the esophagus from the ARSCA, and the patient was without symptoms related to the retroesophageal passage. After embolization of abdominal solid organ injuries, the patient was taken to the operating room for TBE. A GORE-TAG TBE device was successfully deployed via left common femoral access with corresponding access via the right brachial artery with a Jagwire. A POBA balloon expanded the profile of the ARSCA stent after deployment. The procedure was without complications and no endoleak was present. Post-procedure right upper extremity duplex demonstrated excellent, triphasic flow and CTA demonstrated a well-positioned stent graft without endoleak. Given the presence of concomitant blunt cerebrovascular injuries (BCVI), the patient was started on full dose aspirin post-procedure which was continued at discharge. The patient was discharged on hospital day 24 following recovery from other injuries, with no changes on one-month post-discharge CTA. At one-month post-operative clinic visit, given the resolution of BCVI the patient was transitioned to 81mg of aspirin with plan for yearly surveillance.
Conclusion:
With careful patient selection at dedicated aortic centers, TBE can be performed for BTAI in the presence of ARSCA. Important considerations are patient stability, presence of a Kommerell Diverticulum, vertebral artery anatomy, and the passage of the ARSCA relative to other anatomic structures.
Endovascular repair has become the standard of treatment for blunt thoracic aortic injury (BTAI). Aberrant right subclavian artery (ARSCA) complicates treatment of BTAI, with described cases excluding the ARSCA with extra-anatomic bypass when indicated. We describe a novel case of using thoracic branched endograft (TBE) in a patient with an ARSCA presenting with BTAI.
Methods:
We discuss the case of a 38 year old female admitted to our institution after a high speed motor vehicle collision. The patient presented with numerous injuries including multiple cervical spine, rib, and extremity fractures, abdominal solid organ injury, as well as a grade 3 BTAI with ARSCA.
Results:
The above patient was discussed at aortic conference, special consideration was taken to the retroesophageal passage of the ARSCA, however, the associated mediastinal hematoma displaced the esophagus from the ARSCA, and the patient was without symptoms related to the retroesophageal passage. After embolization of abdominal solid organ injuries, the patient was taken to the operating room for TBE. A GORE-TAG TBE device was successfully deployed via left common femoral access with corresponding access via the right brachial artery with a Jagwire. A POBA balloon expanded the profile of the ARSCA stent after deployment. The procedure was without complications and no endoleak was present. Post-procedure right upper extremity duplex demonstrated excellent, triphasic flow and CTA demonstrated a well-positioned stent graft without endoleak. Given the presence of concomitant blunt cerebrovascular injuries (BCVI), the patient was started on full dose aspirin post-procedure which was continued at discharge. The patient was discharged on hospital day 24 following recovery from other injuries, with no changes on one-month post-discharge CTA. At one-month post-operative clinic visit, given the resolution of BCVI the patient was transitioned to 81mg of aspirin with plan for yearly surveillance.
Conclusion:
With careful patient selection at dedicated aortic centers, TBE can be performed for BTAI in the presence of ARSCA. Important considerations are patient stability, presence of a Kommerell Diverticulum, vertebral artery anatomy, and the passage of the ARSCA relative to other anatomic structures.
Aortic Symposium:
Trauma
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