Physician-modified endograft in ruptured aortic arch

Area of Science:

• Vascular Surgery
• Trauma Management
• Endovascular Repair

Background:

• Multi-organ trauma presents complex challenges in managing aortic arch injuries.
• Open surgical repair of aortic arch rupture is often contraindicated due to active bleeding from other injuries.
• Limited treatment options exist for emergent, ruptured traumatic pseudoaneurysms of the aortic arch.

Purpose of the Study:

• To present a novel case of using physician-modified endografts (PMEG) for a ruptured aortic arch pseudoaneurysm in a trauma patient.
• To evaluate the feasibility and effectiveness of PMEG as a damage control procedure in an emergency setting.
• To highlight the potential of endovascular repair when open surgery is not an option.

Main Methods:

• A 27-year-old motorcyclist with multi-organ trauma and a zone 2 aortic arch rupture was treated.
• Physician-modified endograft (PMEG) technology was employed for fenestrated thoracic endovascular aortic repair.
• The procedure was performed as a damage control measure to stabilize the patient for subsequent interventions.

Main Results:

• The PMEG successfully provided temporary aortic supply, enabling completion of other necessary surgical and orthopedic procedures.
• This represents a potentially unique application of PMEG technology in managing emergent, ruptured traumatic aortic arch pseudoaneurysms.
• The endovascular approach was effective in a scenario where open surgery was not feasible.

Conclusions:

• Physician-modified endografts (PMEG) can be effectively utilized for endovascular treatment of aortic arch damage in urgent trauma cases.
• PMEG offers a viable alternative when open surgical repair is precluded by patient instability or active bleeding.
• This case supports the use of PMEG for emergent indications in complex aortic arch injuries.