Limitation of Imaging in Identifying Iatrogenic Aortic Coarctation following Thoracic Endovascular Aortic Repair

• Published in: Annals of vascular surgery Vol. 29; no. 3; pp. 594.e11 - 594.e16
• Main Authors: Thakkar, Rajiv N, Thomaier, Lauren, Qazi, Umair, Verde, Franco, Malas, Mahmoud B
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.04.2015
• Subjects: Accidents, Traffic; Angiography, Digital Subtraction; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - injuries; Aorta, Thoracic - surgery; Aortography - methods; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Humans; Iatrogenic Disease; Male; Motorcycles; Multimodal Imaging; Postoperative Complications - diagnostic imaging; Postoperative Complications - surgery; Predictive Value of Tests; Prosthesis Design; Reoperation; Stents; Surgery; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vascular System Injuries - diagnosis; Vascular System Injuries - etiology; Vascular System Injuries - surgery; Wounds, Nonpenetrating - diagnosis; Wounds, Nonpenetrating - etiology; Wounds, Nonpenetrating - surgery; Young Adult
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2014.10.044

A 21-year-old male suffered blunt trauma from a motor vehicle accident causing thoracic aorta tear. The smallest available stent graft was deployed. Definitive repair was later performed using a 22 × 22 × 116 mm Talent Thoracic Stent Graft. The postoperative course was uneventful. Seventeen months later, he presented with dizziness, chest pain, acute renal failure, malignant hypertension, and troponin elevation. Computed tomography (CT) angiogram and transesophageal echocardiogram did not reveal any dissection, stent stenosis or collapse. Cardiac catheterization showed normal coronary arteries but a 117 mm Hg gradient across the stent graft. Iatrogenic coarctation of the aorta was confirmed with a second measurement during arch angiogram. A Palmaz stent was deployed over the distal end of the previous stent graft with complete resolution of symptoms and gradual normalization of kidney function. This case report demonstrates a need for wider availability and selecting appropriate stent graft in treating traumatic aortic injuries in young patients. It is the first case report of the inability of current imaging modalities in confirming stent collapse. Pressure gradient is a useful tool in confirming stent collapse when clinical scenario does not match CT findings.