Endovascular Treatment of a Traumatic Visceral Aneurysm

A 25-year-old woman sustained numerous gunshot wounds to the abdomen and was taken emergently to the operating theater where she was found to have sustained injuries to the superior mesenteric artery (SMA) and other intra-abdominal organs. The sidewall of the SMA was oversewn with a 4-0 prolene suture to obtain hemostasis intraoperatively. Eighteen months later, the patient presented to the emergency room with hematemesis I hour after a meal. Esophagogastroduodenoscopy revealed a pulsatile mass in the third portion of the duodenum and subsequent arteriography demonstrated a large pseudoaneurysm arising from the proximal SMA. Through a combined right common femoral and left axillary arterial percutaneous approach, a Fluency Tracheobronchial Stent Graft (C.R. Bard Inc., Murray Hill, NJ) was placed via the superior approach into the SMA. An arteriogram was repeated the following day demonstrating a patent SMA with exclusion of the pseudoaneurysm. This report exhibits the delayed complication of an injury to the SMA and a potential endovascular repair using a stent graft recently made available. This technique may offer an alternative therapy to the surgeon managing a patient with complex vascular injuries postlaparotomy.