PMC9630568_01
Computed tomography angiograms obtained before (A) and after (B) endovascular repair of the thoracic aortic injury and fixation of the spinal fractures.
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F1
T9-11, which was classified as Magerl type B3; Figure 1A), luminal stenosis in the thoracic aorta and tortuosity at the level of T10, and a filling defect at the junction of the external iliac and common femoral arteries with severe luminal stenosis (Figure 2A). The serum alanine aminotransferase (ALT) level was elevated at 3028 U/l, the serum creatinine level was 308 micromol/l, and the serum D-dimer level was >20 mg/l. T10 (Figure 1B). The posterior leg muscles were extensively necrotic at the time of the first surgical debridement (Figure 2C). The timeline of treatment is shown in Figure 3.
Filling defect at the right external iliac artery and femoral artery bifurcation with severe luminal stenosis (white arrows) (A). Angiogram obtained on completion of the procedure showing adequate placement of the stent graft with no endoleak or kink (B). Thirteen days after the right lower leg fasciotomy, there was still extensive necrosis in the posterior leg muscles (C). The circumference of the right calf was smaller than that of the left calf at 7 months after flap reconstruction surgery (D). A lateral radiograph obtained after 1 year of follow-up shows the aortic stent graft in situ and stabilization of the vertebral fracture at T10 (E). A repeated CTA performed 1 year of follow-up showed the stent without endoleak (F).
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F2
T9-11, which was classified as Magerl type B3; Figure 1A), luminal stenosis in the thoracic aorta and tortuosity at the level of T10, and a filling defect at the junction of the external iliac and common femoral arteries with severe luminal stenosis (Figure 2A). The serum alanine aminotransferase (ALT) level was elevated at 3028 U/l, the serum creatinine level was 308 micromol/l, and the serum D-dimer level was >20 mg/l. A balloon (12 mm x 80 mm; BSX, USA) was expanded at the site of the stenosis and the stent-graft placement was considered to be adequate with no endoleak or kink (Figure 2B). Angiography showed filling of the defect well beyond the bifurcation of the right femoral artery. T10 (Figure 1B). The posterior leg muscles were extensively necrotic at the time of the first surgical debridement (Figure 2C). The timeline of treatment is shown in Figure 3. Seven months later, follow-up clinical and radiological examinations confirmed that there was no further damage to the right lower limb (Figure 2D). Repeat x-ray and CTA performed 1 year after the patient was discharged showed the stent was stable and without endoleak (Figures 2E,F).
Timeline showing the diagnosis, treatment, and outcome in our patient. CT, computed tomography; CRRT, continuous renal replacement therapy; ALT, alanine aminotransferase; CTA, computed tomography angiography.
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F3
T10 (Figure 1B). The posterior leg muscles were extensively necrotic at the time of the first surgical debridement (Figure 2C). The timeline of treatment is shown in Figure 3.
Changes in the ALT (A) and serum creatinine (B) levels over time. ALT, alanine aminotransferase.
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F4
The ALT and serum creatinine levels decreased with supportive treatment (Figure 4).