Endovascular repair of a thoracic aortic transection 31 years after blunt trauma

A 46-year-old woman presented with a 3-month history of persistent cough and hoarseness with anterior chest pain. A chest radiograph revealed a large upper lobe mass with obliteration of the left lung field. She soon developed hemoptysis, and computed tomography was performed urgently. This showed a ruptured 13-cm thoracic aortic pseudoaneurysm (A). Further inquiry revealed that she was involved in a severe motor vehicle accident at 15 years of age. She was in a “coma” for many weeks, but the patient did not remember any chest trauma or surgery. The patient was urgently taken to the hybrid operating room. Aortography showed a large pseudoaneurysm distal to the subclavian consistent with previous transection (B/Cover). Through femoral access, two TAG devices (W. L. Gore & Associates, Flagstaff, Ariz) were placed (C). Balloon angioplasty was not performed. The patient was discharged on postoperative day 2 doing well with no neurologic sequelae. At 6-month follow-up, the patient was doing well with resolution of all symptoms. Computed tomography angiography showed no endoleak and the aneurysm sac to measure 9.6 cm in diameter (D). There was re-expansion of the lung field as well. The patient has consented to the publication of this report along with its accompanying operative images.