Stent-graft repair of acute traumatic thoracic aortic transection with intentional occlusion of the left subclavian artery: Case report

The standard treatment for acute traumatic aortic transection remains primary repair with interposition grafting via left thoracotomy. Associated injuries may make conventional repair a prohibitive risk. Stent-grafts are in clinical trials in the United States for the treatment of atherosclerotic aortic aneurysms.(1-3) Investigational work is underway in many centers in this country for the application of stent-grafts in the treatment of traumatic aortic injury.(4-8) This case report reflects such an application of this technological advancement. Presented is a case of an acute traumatic aortic transection in a high-risk patient with multiple injuries treated on a compassionate-use basis with a stent-graft. Extensive, bilateral pulmonary contusions contraindicated single-lung ventilation and conventional, operative repair including left thoracotomy with aortic clamp and sew, and left heart and/or full cardiopulmonary bypass. Because of injury proximity, the left subclavian ostium was intentionally covered, occluding antegrade subclavian artery flow. No further surgical bypass to the subclavian artery was clinically required after stent-graft placement.