Hypertension, acute stent thrombosis, and paraplegia 6 months after thoracic endovascular aortic repair for blunt thoracic aortic injury in a 22-year-old patient

Autor: Federico Faccenna, J Jabbour, Luigi Irace, Bruno Gossetti, S. Venosi, Ombretta Martinelli, R. Gattuso, Alban Malaj
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
medicine.medical_specialty
Time Factors
Computed Tomography Angiography
medicine.medical_treatment
aneurism
Aorta
Thoracic
030204 cardiovascular system & hematology
Prosthesis Design
Wounds
Nonpenetrating
Aortography
03 medical and health sciences
Blood Vessel Prosthesis Implantation
Young Adult
0302 clinical medicine
Blood vessel prosthesis
medicine.artery
medicine
Thoracic aorta
Humans
030212 general & internal medicine
Thrombus
Antihypertensive Agents
Paraplegia
Aorta
business.industry
Endovascular Procedures
Accidents
Traffic
Stent
Thrombosis
General Medicine
Vascular System Injuries
medicine.disease
Magnetic Resonance Imaging
Surgery
Blood Vessel Prosthesis
Treatment Outcome
Cardiology and Cardiovascular Medicine
Cardiothoracic surgery
Descending aorta
Hypertension
Stents
Radiology
business
Platelet Aggregation Inhibitors
Popis: Thoracic endovascular aortic repair (TEVAR) is a less invasive option for managing traumatic injuries of the descending aorta in polytraumatized patients. Concerns arise when treating young patients with TEVAR. A 22-year-old male was admitted to the emergency department following a high-impact road traffic collision. Whole-body computed tomography (CT) scan documented multiple injuries, including rupture of descending thoracic aorta just below the isthmus. There was no evidence of paraplegia or stroke. We decided to treat him in an endovascular fashion with a Zenith Cook (Cook Incorporated, Bloomington, IN) endograft. Final angiography confirmed the proper positioning of the device, no infoldings, and the optimal filling of the thoracic aorta downstream of the endoprosthesis. In the postoperative period, the patient showed high blood pressure which was treated with 4 different antihypertensive drugs. He was discharged on cardioaspirine. CT scan control was scheduled after 30 days and 6 months, but he referred to our emergency department after less than 6 months with paraplegia, abdominal pain, and acute renal failure. He had independently discontinued antiplatelet therapy 3 months before. Emergency CT control documented the presence of intimal flap and thrombus at the distal edge of the device. The magnetic resonance imaging revealed ischemic damage of the spinal cord. We decided to reline the endograft using another Zenith Cook device with very good results. Renal failure and bowel pain gradually improved, but paraplegia is still present. TEVAR is the most suitable treatment for blunt thoracic aortic injury in the modern era. Concerns arise from what can happen to a young aorta receiving a stiff endovascular graft that should be carried all lifelong. These devices have been associated with acute hypertension and cardiac remodeling. Less stiffer stent grafts should be studied for young patients. High attention must be posed in the follow-up for the immediate resolution of eventual problems.
Databáze: OpenAIRE
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