Endovascular treatment of a blunt thoracic aortic injury in adolescents: a case report.

Abstract

Background: Blunt thoracic aortic injury (BTAI) in adolescents is a rare but life-threatening condition associated with a high mortality rate. Patients with BTAI often present with multiple severe injuries, which can complicate the use of traditional surgical approaches. While thoracic endovascular aortic repair (TEVAR) has become a standard treatment for traumatic aortic injuries in adults, its application in pediatric cases remains relatively uncommon and is primarily supported by limited case reports. Furthermore, medium- and long-term follow-up data are lacking. We report the case of a 16-year-old male with BTAI and multiple organ injuries who was successfully treated with TEVAR and remained complication-free during a 69-month follow-up period.

Case description: A 16-year-old male sustained severe multisystem organ injuries after a fall from a five-story building. The patient was critically ill and required intubation during transport. Emergency computed tomography (CT) revealed extensive injuries, including: a descending aorta injury with pseudoaneurysm, bilateral pulmonary contusions with moderate left hemothorax, right pneumothorax, retroperitoneal effusion, right renal contusion with perirenal hematoma, Fractures of the skull base, upper and lower jaw, lumbar spine, sacrum fractures, and severe open wounds in the mouth, right knee joint, and bilateral heels. A multidisciplinary team determined that aortic injury repair should be prioritized. We ultimately performed an unconventional endovascular aortic repair in this adolescent patient. The procedure was completed efficiently without complications, and subsequent interventions successfully addressed the remaining injuries. The patient required a total hospital stay of 733 days and underwent 13 surgical procedures before being successfully discharged following rehabilitation. As of September 2024, the patient remains alive with no complications related to the arterial injury.

Conclusions: TEVAR represents a safe and viable short-term treatment option for adolescents with multiple traumatic injuries. The 69-month follow-up in this case confirms procedural success and suggests the effectiveness of TEVAR in this patient population.