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

Aortic and cardiovascular remodelling after thoracic endovascular aortic repair for blunt traumatic aortic injury in younger patients: A narrative review of physiological and clinical outcomes

Blunt traumatic aortic injury (BTAI) is severe, often fatal in younger populations due to high-energy deceleration mechanisms. Thoracic endovascular aortic repair (TEVAR) has revolutionised BTAI treatment, surpassing the previously standard open surgical repair in mortality and complication rates. Despite its success, concerns arise regarding TEVAR's long-term effects, especially in younger BTAI patients. Key physiological changes following TEVAR include alterations in aortic size, shape, compliance and flow dynamics, leading to loss of the Windkessel effect and a consequent increased pulse wave velocity and decreased radial strain, which can contribute to the development of hypertension. These alterations also predispose patients to changes in cardiovascular flow (increased reverse systolic flow, reduced maximum velocity and altered helical flow), potentially increasing the risk of left ventricular dysfunction and coronary artery disease. Physiological changes also increase the likelihood of complications such as graft migration. Clinical outcomes of TEVAR for BTAI have generally been favourable, with significant reductions in mortality and cerebrovascular accident rates compared to open surgical repair. However, long-term complications, including the need for re-interventions, remain a concern, though studies suggest these are infrequent. The durability of TEVAR in younger patients, who may experience decades of device use, poses unique challenges, particularly due to the natural progression of aortic morphology over time. Therefore, adapting TEVAR to the physiological needs of younger BTAI patients is essential. Developing more compliant endografts and using shorter stents with improved materials can help minimise structural and haemodynamic changes and enhance cardiovascular outcomes, supporting the long-term health of this vulnerable population.

Blunt Thoracic Aortic Injury: A Life-Threatening Emergency on Air Medical Transportation

A 54-year-old male driver was injured in a car crash in which his front-side passenger died at the scene. The initial assessment indicated that he was conscious and able to recall the accident. His vital signs included blood pressure of 155/95 mm Hg, heart rate of 112 beats/min, and respiratory rate of 21 breaths/min, and he complained of stabbing retrosternal pain. A palpable sternal fracture with a tender contusion, a discrepancy between the blood pressures between the arms, and diminished femoral pulses were other findings. With a thoracic aortic pseudoaneurysm suspicion, the emergency physician maintained the patient's systolic blood pressure around 100 mm Hg and his heart rate less than 100 beats/min. Because of the need for urgent medical interventions, the emergency physician decided to transport him by air to the nearest advanced trauma center. After accordance with the trauma center and the air medical crew, the air transportation began. The patient subsequently decompensated with bradycardia and hypotension to cardiac arrest, for which 30 minutes of cardiopulmonary resuscitation unfortunately proved unsuccessful. The forensic report indicated an aortic pseudoaneurysm rupture of the proximal descending aorta with a massive hematoma that was a possible cause of death.