Limitation of imaging in identifying iatrogenic aortic coarctation following thoracic endovascular aortic repair

Rajiv N. Thakkar, Lauren Thomaier, Umair Qazi, Franco Verde, Mahmoud B. Malas

Research output: Contribution to journalArticle

Abstract

A 21-year-old male suffered blunt trauma from a motor vehicle accident causing thoracic aorta tear. The smallest available stent graft was deployed. Definitive repair was later performed using a 22 × 22 × 116 mm Talent Thoracic Stent Graft. The postoperative course was uneventful. Seventeen months later, he presented with dizziness, chest pain, acute renal failure, malignant hypertension, and troponin elevation. Computed tomography (CT) angiogram and transesophageal echocardiogram did not reveal any dissection, stent stenosis or collapse. Cardiac catheterization showed normal coronary arteries but a 117 mm Hg gradient across the stent graft. Iatrogenic coarctation of the aorta was confirmed with a second measurement during arch angiogram. A Palmaz stent was deployed over the distal end of the previous stent graft with complete resolution of symptoms and gradual normalization of kidney function. This case report demonstrates a need for wider availability and selecting appropriate stent graft in treating traumatic aortic injuries in young patients. It is the first case report of the inability of current imaging modalities in confirming stent collapse. Pressure gradient is a useful tool in confirming stent collapse when clinical scenario does not match CT findings.

Original languageEnglish (US)
JournalAnnals of Vascular Surgery
Volume29
Issue number3
DOIs
StatePublished - Apr 1 2015

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Aortic Coarctation
Stents
Thorax
Transplants
Angiography
Tomography
Malignant Hypertension
Troponin
Aptitude
Wounds and Injuries
Dizziness
Motor Vehicles
Cardiac Catheterization
Chest Pain
Thoracic Aorta
Acute Kidney Injury
Accidents
Dissection
Coronary Vessels
Pathologic Constriction

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Limitation of imaging in identifying iatrogenic aortic coarctation following thoracic endovascular aortic repair. / Thakkar, Rajiv N.; Thomaier, Lauren; Qazi, Umair; Verde, Franco; Malas, Mahmoud B.

In: Annals of Vascular Surgery, Vol. 29, No. 3, 01.04.2015.

Research output: Contribution to journalArticle

Thakkar, Rajiv N. ; Thomaier, Lauren ; Qazi, Umair ; Verde, Franco ; Malas, Mahmoud B. / Limitation of imaging in identifying iatrogenic aortic coarctation following thoracic endovascular aortic repair. In: Annals of Vascular Surgery. 2015 ; Vol. 29, No. 3.
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