A rare case of a blunt thoracic aortic injury in a patient with an aberrant right subclavian artery: A case report and literature review. (February 2021)

• Record Type: Journal Article
• Authors: Diaz, Brandon; Meneses, Evander; Kinslow, Kyle; McKenney, Mark; Elkbuli, Adel; Boneva, Dessy
• Is Part Of: International journal of surgery case reports. Volume 79(2021)
• Page Start: 172
• Page End: 177
• Publication Date: 2021-02
• Subjects: BTAI blunt thoracic aortic injury -- MVC motor vehicle collision -- TEVAR Thoracic Endovascular Aortic Repair -- GCS Glasgow Coma Scale -- CT Computed Tomography -- CTA Computed Tomography Angiography -- MRI Magnetic Resonance Imaging -- PTFE polytetrafluoroethylene -- HIT Heparin Induced Thrombocytopenia -- HITT Heparin Induced Thrombocytopenia and Thrombosis -- ISS injury severity score -- NTDB-RDS Nataional Trauma Data Bank Research Dataset; Aberrant right subclavian artery -- Blunt thoracic aortic injury -- Carotid to subclavian bypass -- TEVAR -- Polytrauma; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.01.017
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Blunt thoracic aortic injuries are life threatening and require urgent intervention. Rare presentation of a blunt thoracic aortic injury in a patient with an aberrant right subclavian artery off the aortic arch distal to the takeoff of the left subclavian artery. An aberrant right subclavian artery originating from the aortic arch, distal to the left subclavian artery is an anatomic variant that adds significant complexity to TEVAR. Abstract: Introduction: Blunt thoracic aortic injuries (BTAIs) are an uncommon traumatic injury that if not treated promptly, can result in death. We present the case of a BTAI with aberrant aortic anatomy. Presentation of case: A 60-year-old female was involved in a motor vehicle crash where she suffered significant polytrauma including a BTAI. She was also found to have an aberrant right subclavian artery originating from the aortic arch. Thoracic Endovascular Aortic Repair (TEVAR) with a right common carotid artery to right subclavian artery bypass was accomplished. She required three more vascular surgical interventions, two for persistent type II endoleak and the third for left upper extremity acute limb ischemia. She had a 2-month hospital course for her devastating injuries and was eventually discharged home. A follow-up CT angiogram showed a stable thoracic aortic arch stent. Discussion: BTAIs are uncommon in the trauma population. In our patient who had an aberrant right subclavian artery, further procedures were required in the form of a right common carotid artery to right subclavian artery bypass and embolizations to resolve endoleaks. Conclusion: Blunt thoracic aortic injuries are life threatening and require urgent intervention. TEVAR is associated with better outcomes. An aberrant right subclavian artery originating from the aortic arch, distal to the left subclavian artery is an anatomic variant that adds significant complexity to TEVAR. TEVAR is still an option for repair of blunt thoracic aortic injuries despite anatomic variations as open repair still carries an increased risk of morbidity and mortality.