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Background <p>Traumatic aortic transection is a life-threatening injury with an acute mortality rate approaching 80%, typically resulting from high-energy blunt trauma, such as motor vehicle collisions. Without intervention, the overall mortality rate increases to 90–94%, primarily due to the rupture of pseudoaneurysms or expanding hematoma leading to exsanguination. Although delayed surgical repair may decrease immediate mortality, it is associated with significant perioperative risks. Endovascular techniques are becoming increasingly prevalent and have demonstrated lower morbidity and mortality rates in adult trauma patients compared with traditional open surgery.</p> Case presentation <p>A 32-year-old female Filipino healthcare worker presented to our institution in February 2021 following a high-speed head-on collision with seat-belt-related trauma. She exhibited respiratory distress, mild hypotension, and abdominal wall bruising. Initial hemoglobin was 12.6&#xa0;g/dL and remained stable. Imaging (computed tomography angiography, magnetic resonance angiography) revealed a right pneumothorax, along with a partial pulmonary contusion, a suprarenal aortic transection with severe luminal narrowing, distortion of the celiac and superior mesenteric artery origins, and a small periaortic and suprarenal hematoma, without contrast extravasation. Following stabilization, including right-sided chest tube placement and comprehensive discussion of all therapeutic options, the patient declined open surgical repair. Due to the severe suprarenal aortic narrowing, fenestrated endograft deployment was not feasible. On 4 March 2021, she underwent percutaneous endovascular repair using a self-expanding nitinol stent (Sinus XL Flex, 14 × 80&#xa0;mm; OptiMed, Germany) via right common femoral artery access.</p> <p>The procedure was successful without complications, and she was discharged on postoperative day 3 with aspirin therapy. Follow-up imaging at 3 and 12&#xa0;months demonstrated near-complete aortic restoration and preserved renal and visceral perfusion.</p> Conclusion <p>This case highlights the efficacy of a novel endovascular approach for nonhemorrhagic traumatic aortic transection. The open-cell nitinol stent provides immediate stabilization of the aortic wall while preserving perfusion to branch vessels, thereby preventing rupture and avoiding fatal outcomes. This unique, minimally invasive technique presents a viable alternative to conventional endografts, particularly in anatomically complex cases of nonhemorrhagic traumatic aortic transection.</p>

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Endovascular treatment of a traumatic aortic transection via implantation of self-expanding nitinol stent with open-cell design: a case report

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  • 发表日期：

    2025年12月29日

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  • Ali Keivanjah

摘要

Background

Traumatic aortic transection is a life-threatening injury with an acute mortality rate approaching 80%, typically resulting from high-energy blunt trauma, such as motor vehicle collisions. Without intervention, the overall mortality rate increases to 90–94%, primarily due to the rupture of pseudoaneurysms or expanding hematoma leading to exsanguination. Although delayed surgical repair may decrease immediate mortality, it is associated with significant perioperative risks. Endovascular techniques are becoming increasingly prevalent and have demonstrated lower morbidity and mortality rates in adult trauma patients compared with traditional open surgery.

Case presentation

A 32-year-old female Filipino healthcare worker presented to our institution in February 2021 following a high-speed head-on collision with seat-belt-related trauma. She exhibited respiratory distress, mild hypotension, and abdominal wall bruising. Initial hemoglobin was 12.6 g/dL and remained stable. Imaging (computed tomography angiography, magnetic resonance angiography) revealed a right pneumothorax, along with a partial pulmonary contusion, a suprarenal aortic transection with severe luminal narrowing, distortion of the celiac and superior mesenteric artery origins, and a small periaortic and suprarenal hematoma, without contrast extravasation. Following stabilization, including right-sided chest tube placement and comprehensive discussion of all therapeutic options, the patient declined open surgical repair. Due to the severe suprarenal aortic narrowing, fenestrated endograft deployment was not feasible. On 4 March 2021, she underwent percutaneous endovascular repair using a self-expanding nitinol stent (Sinus XL Flex, 14 × 80 mm; OptiMed, Germany) via right common femoral artery access.

The procedure was successful without complications, and she was discharged on postoperative day 3 with aspirin therapy. Follow-up imaging at 3 and 12 months demonstrated near-complete aortic restoration and preserved renal and visceral perfusion.

Conclusion

This case highlights the efficacy of a novel endovascular approach for nonhemorrhagic traumatic aortic transection. The open-cell nitinol stent provides immediate stabilization of the aortic wall while preserving perfusion to branch vessels, thereby preventing rupture and avoiding fatal outcomes. This unique, minimally invasive technique presents a viable alternative to conventional endografts, particularly in anatomically complex cases of nonhemorrhagic traumatic aortic transection.