Cervicothoracic screwdriver impalement causing traumatic aortic injury managed with TEVAR

Penetrating neck injuries are uncommon but carry high mortality due to the proximity of major vessels and the aerodigestive tract. We report a woman in her 80s who presented with a 40-cm flat-head screwdriver impaled in the right lower neck at the thoracic inlet. Computed tomographic angiography (CTA) demonstrated a distal thoracic aortic arch pseudoaneurysm with mediastinal haemorrhage. Although initially haemodynamically stable, she developed airway compromise and underwent emergent open tracheostomy in a hybrid operating room. Thoracic endovascular aortic repair excluded the pseudoaneurysm and achieved hemorrhage control, after which the screwdriver was removed under controlled conditions. Her postoperative course was notable for transient atrial fibrillation and a duodenal bulb ulcer bleed, both managed appropriately. She was discharged home on postoperative day 19. Early airway control, endovascular hemorrhage control before extraction and multidisciplinary hybrid-operating room (OR) capability were key to survival.