Endovascular and open repair of traumatic great vessel injuries: A case series

8^th International Conference on Surgery & Anesthesia

March 24-25, 2022 Webinar

Kelly Ruecker

Royal Melbourne Hospital, Australia

Scientific Tracks Abstracts: Journal of Surgery

Abstract :

Background: Blunt thoracic aortic injury carries a high mortality risk, with only 10% of patients surviving to hospitalisation. We present three cases of aortic arch and branch injuries treated with endovascular, open and hybrid vascular repair. Case Descriptions: Case 1: A 33yo male presented post MVC. CT imaging demonstrated a complex Type B dissection of the aortic isthmus with several short intimal flaps arising distal to the left SCA origin. Emergency TEVAR was performed. Case 2: A 19yo female presented post MVC. CT showed pseudoaneurysm at the origin of the BCT. Attempts at excluding the pseudoaneurysm with an endovascular stent were unsuccessful and proceeded to a median sternotomy and BCT interposition graft repair under cardiopulmonary bypass. Case 3: A 24yo male presented post motorcycle crash versus truck with CT imaging demonstrating a left SCA avulsion. Proximal control was temporised using TEVAR and control obtained via ligation of the SCA via a supraclavicular incision with subsequent left common carotid to SCA bypass. Discussion: Blunt thoracic great vessel trauma is rare, accounting for less than 5% of traumatic vascular injuries. Endovascular stents have been increasingly described in the literature as a safe alternative to open repair for thoracic aortic and subclavian injuries. Advantages include a minimally invasive procedure, short procedure time and avoidance of cardiopulmonary bypass, however the mainstay of treatment for thoracic aortic and aortic branch injuries has been open repair. Conclusion: Initial attempt at endovascular repair should be utilised in traumatic aortic and branch injuries however success rates are variable and should prompt conversion to open repair if unsuccessful. Recent Publications Ruecker K, Wilkie B, Marascia D, Furlong T, Tang J, Wang W. Pylephlebitis of the inferior mesenteric vein: a rare complication of sigmoid diverticulitis. ANZ Journal of Surgery. 2021

Biography :

Kelly Ruecker is a pre-SET General Surgery and Trauma registrar at Royal Melbourne Hospital, Australia. She has a keen interest in trauma surgery, surgical oncology and medical education.