Emergency endovascular treatment of an acute traumatic rupture of the thoracic aorta complicated by a distal low-flow syndrome

We report the case of a patient who suffered major trauma following a motor cycle accident that resulted in multiple fractures, bilateral hemopneumotho rax, pulmonary contusions, and an isthmic rupture of the aorta with a pseud oaneurysm compressing the descending aorta. This compression was responsibl e for distal hypotension and low flow, leading to acute renal insufficiency and massive rhabdomyolysis. Due to the critical clinical status of the pat ient, which prevented any type of open thoracic surgery, endovascular treat ment was performed. An initial stent-graft permitted alleviation of the com pression and the re-establishment of normal hemodynamic conditions, but its low position did not allow sufficient coverage of the rupture. A second st ent-graft permitted total exclusion of the pseudoaneurysm while preserving the patency of the left subclavian artery.