PMC8652008_01
Sagittal views of the descending aorta at different times. Panel A demonstrates sagittal view of the thoracic aorta at the time of the first trauma. The Asterix (*) demonstrates the location of the grade III rupture distal to the LSA near the ligamentum arteriosum. Panel B demonstrates the CTA scan image 20 days after TEVAR with very subtle thrombus formation, which resulted in continuation of the anticoagulation. Panel C shows the CTA at the time of thrombotic occlusion of distal two thirds of the stentgraft.
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fig1
He had multiple injuries, including a traumatic grade III pseudoaneurysm of the descending thoracic aorta, at the level of the ligamentum arteriosum (Fig. 1A). September 2017 (T = 12 months). The CTAs showed limited amounts of intragraft wall mounted thrombus, mainly involving the distal third of the stentgraft (Fig. S1). CTA demonstrated occlusion of the middle and distal third of the thoracic stentgraft without signs of endoleak, collapse, migration, or structural device alterations (Fig. 1).
A. Peri-operative image after a left thoracotomy. The zone two aortic arch and at left subclavian artery clamps can be seen. The stentgraft is removed from the descending aorta. B. Image following removal of the stentgraft. The clamp at the aortic arch/zone 2 can be seen. The LSA clamp has been exchanged for a vessel loop. Please note the white arrow showing the old contained rupture/pseudoaneurysm of the descending aorta, just around the ligamentum arteriosum.
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fig2
After clamping on the aorta proximal and distal to the stentgraft (Fig. 2A), the stentgraft was removed (Fig. 2B) and replaced by a 22 mm Dacron graft (Braun Medical).
Removedstentgraft. Removed stentgraft with a part of the thoracic aortic wall ( ) demonstrated at panel A. Panel B demonstrates the proximal part of the stentgraft with thrombus formation (*) and the true lumen (+-). Panel C demonstrates the distal part with occlusive thrombus formation of almost the entire lumen ( ), and a false lumen (#) due to re-expansion of the endograft outside the body.
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fig3
Gross examination of the removed stentgraft showed intraluminal thrombus formation in the entire graft with occlusion in the middle and distal third of the endograft (Fig. 3).