Endovascular Repair of Traumatic Aortic Injury in a Pediatric Patient

BACKGROUND: Management of traumatic aortic injury (TAI) in a pediatric patient presents a unique surgical challenge. We report an endovascular repair of TAI in a 14 year old girl with the off label use of an iliac limb (Excluder, WL Gore, Flagstaff, AZ).
METHODS: A 14 year old girl presented to our institution after a motor vehicle accident. She had sustained multiple injuries including intracranial hemorrhage and TAI. She underwent a ventriculostomy and was subsequently admitted to the trauma intensive care unit. Due to the severity of her associated injuries, the patient was not a candidate for open repair of the TAI. Her follow-up CT scan showed an enlarging traumatic pseudoaneurysm in the proximal descending thoracic aorta . The aortic diameter proximal to the area of injury was 14 mm. An endovascular repair with an off label use of an iliac limb was offered to the family. The endovascular repair was performed using a 14mm x 10mm iliac contralateral leg endoprosthesis (Excluder, WL Gore, Flagstaff, AZ). Diagnostic and completion thoracic angiograms are shown below (Figures 1&2).
RESULTS: The procedure was technically unremarkable, and the patient had an uneventful postoperative course. A postoperative CT scan demonstrated successful exclusion of the pseudoaneurysm without any evidence of endoleak. Her neurological status, however, remained poor and she was subsequently transferred to a long term care facility in stable condition.
CONCLUSIONS: Endovascular repair of TAI in a pediatric patient is technically feasible with the off label use of an iliac limb. This procedure can be used as a bridge to future repair in patients who are unable to tolerate open surgery.