[Acute post-trauma dissection of the descending thoracic aorta]

BACKGROUND

Traumatic injury to the descending thoracic aorta other than the isthmus is rare, and little known. Acute post-trauma rupture may occur in a context of multiple or rarely unique localizations.

CASE REPORT

We report the case of a young man who was the victim of multiple injuries with an isolated rupture of the descending thoracic aorta. Early diagnosis and adapted endovascular treatment led to favorable outcome.

CONCLUSION

In 90% of cases, acute post-trauma rupture of the aorta in a single localization involve the isthmus. Rupture of the descending aorta is more exceptional but must not be missed. The pathophysiological mechanism and appropriate management are discussed in light of a review of the literature.

[Emergency endovascular treatment for ruptured post-traumatic pseudoaneurysm of the superior gluteal artery]

Pseudoaneurysms of the gluteal arteries are rare, often secondary to blunt or penetrating pelvic trauma. These pseudoaneurysms are initially asymptomatic and manifest after a variable delay ranging from a few weeks to many years after the initial trauma. The spontaneous outcome can be fatal in case of rupture. Previously, treatment of gluteal pseudoaneurysms was exclusively surgical, but the advent of endovascular techniques revolutionized management practices by decreasing perioperative morbidity and offering results comparable to those of surgery. We report the case of a patient admitted for emergency management of a ruptured post-traumatic pseudoaneurysm of the superior gluteal artery that had occurred 20 days after penetrating buttock trauma. Selective embolization was successful.

[Spontaneous false aneurysm of the extracranial internal carotid artery - during pregnancy]

Extracranial carotid false aneurysms are rare but serious because of the high risk of rupture and thromboembolic ischemic strokes. Although hemodynamic and hormonal physiological changes in pregnant women may favor arterial rupture and the development of false aneurysms, only one case of extracranial carotid false aneurysm related to pregnancy has been reported in the literature. Surgical repair is still the treatment of choice of these lesions. We report a case of spontaneous false aneurysm of the extracranial internal carotid artery occurring at the end of pregnancy. The surgical procedure consisted in resection of the false aneurysm with interposition of a prosthetic graft. The follow-up was uneventful.

[An axillary-subclavian artery aneurysm in pre-rupture revealing Marfan syndrome]

Marfan syndrome is an autosomal dominant disorder of connective tissue which has many clinical symptoms and whose prognosis depends on associated cardiovascular complications, dominated by proximal aortic disorders. Peripheral arterial aneurysms are rare during Marfan syndrome and are exceptionally indicative of the disease. We report the case of a large aneurysm of the axillary-subclavian artery in pre-rupture revealing a new case of Marfan syndrome. Treatment consisted in surgical repair by resection of the aneurysm and performing a venous bypass graft; the postoperative course was uneventful.

[Traumatic dissection of the left renal pedicle in a young adult]

Blunt trauma rarely causes renal pedicle dissection. Clinical signs are minimal and inconsistently reported. The diagnosis is based on computed tomographic angiography; arteriography is still useful when revascularization is considered. We report here a case of traumatic dissection with thrombosis of a juxta-aortic renal pedicle monitored in the intensive care unit. An endovascular procedure could not be proposed because of the juxta-aortic localization.

[Claude Bernard-Horner syndrome revealing spontaneous aneurysm of the vertebral artery]

False aneurysms of the extracranial vertebral artery (FAVA) are rare because of the path of the artery at the level of the transverse holes. They can be secondary to penetrating cervical trauma, spontaneous in the course of an angiopathy such as Ehlers-Danlos syndrome, or iatrogenic. We report the case of a 31-year-old woman who presented a syndrome of Claude Bernard-Horner related to a spontaneous FAVA. The angioscanner confirmed the diagnosis and the patient underwent successful surgical treatment of the false aneurysm with ligature of the vertebral artery. Outcome was favorable.

[Peripheral arterial pseudo-aneurysm in Behçet's disease: Report of two cases]

Behçet's disease is a systemic vasculitis of unknown etiopathogenesis. Arterial events such as pseudo-aneurysms are rare and may be the mode of occurrence of the disease. These pseudo-aneurysms tend, regardless of size, to progress rapidly to life-threatening rupture. We report two cases of arterial pseudo-aneurysms that ruptured. Treatment consisted of surgical repair in one case and arterial ligation in the other; the postoperative course was uneventful in both cases.

[Endovascular treatment of acute limb ischemia occurred after popliteal stent fracture]

Angioplasty stenting of popliteal artery lesions is a common procedure in endovascular surgery. Stent fractures in popliteal artery maybe asymptomatic or cause restenosis, false-aneurysm or acute thrombosis. We report one case of acute limb ischemia occurred after a popliteal stent fracture placed four months earlier. The patient underwent an angioplasty stenting, completed with thrombolysis and thrombectomy. This case-report aims to illustrate complications of stent fracture in popliteal artery and possibility's to manage it by endovascular approach.

[Endovascular treatment of intra-thoracic left subclavian artery aneurysm]

Aneurysms of the subclavian artery are rare, and remain asymptomatic until complications. We report one case of atherosclerotic aneurysm of the proximal portion of the left subclavian artery fortuitously discovered and successfully treated by endovascular stent graft. This case report aims to illustrate endovascular procedures in the management of difficult access lesions or in high-risk surgical patients.