Urgent endovascular aorta repair for a rupture of a traumatic infrarenal aortic dissection: Case report and review of literature

Traumatic aortic injury is a life-threatening condition usually followed by blunt trauma with damage at the thoracic aorta. Abdominal aortic injuries are rare and usually seen with seatbelt trauma. Timing and approach of treatment are associated with significant morbidity and mortality. This case concerns a 66-year-old man with a high impact trauma after a fall from height. Upon presentation in our level two trauma center, he was conscious but hemodynamically unstable. Computer Tomography scan revealed multiple rib, spine and pelvic fractures with bilateral lung contusions warranting a transfer to a level one trauma center. However, an infrarenal aortic dissection with a retroperitoneal rupture and active bleeding necessitated acute surgical intervention. He was treated endovascularly with an off-the-shelf aortic stent graft which is meant for aortic aneurysm repair. Surgery was performed percutaneously under local anesthetic. Other fractures were treated conservatively. Postoperatively, the patient made a swift recovery without any complications in follow-up. As this case demonstrates, urgent endovascular repair of a traumatic infrarenal aortic injury can be done quickly with a minimally invasive approach with conventional stent graft systems thereby reducing the high morbidity and mortality rates associated with this life-threatening condition.