Emergency endovascular repair of blunt thoracic aortic injury-related pseudoaneurysm using a castor single-branched stent graft: a case report and literature review

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Blunt thoracic aortic injury (BTAI) is a severe traumatic condition caused by sudden deceleration and is associated with high mortality. When a complete aortic rupture does not occur, a thoracic aortic pseudoaneurysm (TAP) may develop, carrying a substantial risk of rupture and death. Thoracic endovascular aortic repair (TEVAR) has become the primary treatment modality for BTAI; however, its management remains challenging in patients with lesions adjacent to the left subclavian artery (LSA) and an insufficient proximal landing zone. Case report A 38-year-old woman was admitted to the emergency department with precordial and shoulder-back pain that persisted for 2 h following a motor vehicle accident. Computed tomography angiography (CTA) revealed a pseudoaneurysm in the aortic isthmus accompanied by bilateral pleural effusion. Dynamic clinical observations demonstrated persistent pain, a progressive increase in pleural effusion volume, and a gradual decline in hemoglobin levels, suggesting unstable grade III BTAI with a high risk of rupture. Because the distance between the pseudoaneurysm entry tear and the LSA origin was less than 10 mm and the distance between the left common carotid artery (LCCA) and the LSA was approximately 7 mm, conventional TEVAR was unlikely to provide an adequate proximal landing zone. Emergency endovascular repair using a Castor single-branched stent-graft system was performed under general anesthesia. Intraoperative angiography demonstrated complete exclusion of the pseudoaneurysm, with preserved blood flow in the LSA and supra-aortic branch vessels. The postoperative course was uneventful. At the 3-year follow-up, CTA demonstrated satisfactory stent positioning without evidence of endoleak, stent migration, or branch occlusion as well as favorable aortic remodeling without recurrent visualization of the pseudoaneurysm. This case suggests that the Castor single-branched stent-graft may be a minimally invasive treatment option for patients with blunt thoracic aortic injury-related pseudoaneurysm involving or adjacent to the left subclavian artery, although further studies are required to confirm its safety and efficacy.