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Penetrating traumatic aortic arch injury: a unique case report presentation
Rudo Pswarayi1, Rubinette Robbertze1, Gloria Tshimbidi1
1Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Annals of Medicine and Surgery (2012)
|August 11, 2025
Summary
Traumatic aortic arch injuries can be managed nonoperatively in select cases. This case report details successful conservative management of a delayed penetrating aortic injury, emphasizing careful monitoring and patient selection.
Area of Science:
- Cardiovascular Surgery
- Trauma Surgery
- Vascular Surgery
Background:
- Penetrating traumatic aortic arch injuries are rare but associated with high mortality.
- Treatment options include open surgical repair and endovascular repair, with choices based on patient stability and anatomy.
- Delayed presentations pose unique management challenges.
Observation:
- A 38-year-old male presented with a delayed penetrating aortic arch injury after a stab wound.
- Initial assessment showed hemodynamic instability and imaging revealed an aortic injury with a pseudoaneurysm.
- The patient was transferred to a Level 1 trauma center for further management.
Findings:
- Conservative management with serial computed tomography (CT) angiography monitoring was initiated.
- The aortic pseudoaneurysm remained stable over several weeks without expansion.
- Successful nonoperative management was achieved, and the patient was discharged with outpatient follow-up.
Implications:
- This case highlights the potential for successful nonoperative management of selected delayed penetrating traumatic aortic arch injuries.
- Multidisciplinary care, close monitoring, and serial imaging are crucial for conservative approaches.
- Further research is needed to establish clear indications and outcomes for nonoperative management in these complex injuries.
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