Endovascular Management of Traumatic Aortic Arch Pseudoaneurysm With Concomitant Left Subclavian Artery Occlusion and Dissection: A Multidisciplinary Case Report

TL;DR

A young man with severe aortic and subclavian artery injuries was successfully treated using a combined endovascular approach, demonstrating the effectiveness of multidisciplinary strategies in complex trauma cases.

Contribution

This case report introduces a novel multidisciplinary endovascular strategy for treating complex aortic and subclavian artery injuries in anatomically challenging scenarios.

Findings

Multidisciplinary endovascular repair successfully managed a traumatic aortic arch pseudoaneurysm and left subclavian artery dissection.

Use of the Medtronic Valiant™ Captivia™ and Fluency™ Plus stent grafts enabled effective exclusion of the pseudoaneurysm and restoration of subclavian artery flow.

Precise stent deployment and hybrid revascularization techniques proved feasible in ultra-short proximal landing zones in young trauma patients.

Abstract

Blunt thoracic aortic injury (BTAI) with concurrent subclavian artery dissection poses complex challenges. This case highlights the role of multidisciplinary endovascular strategies in managing anatomically hostile injuries. We present a case of a 22-year-old male who presented with BTAI (grade 3 aortic arch pseudoaneurysm) and left subclavian artery (LSA) dissection/occlusion after a three-meter fall. Thoracic endovascular aortic repair (TEVAR) with a Medtronic Valiant™ Captivia™ system thoracic stent graft and LSA stenting using a Fluency™ Plus endovascular stent graft was performed. Postoperative imaging confirmed pseudoaneurysm exclusion and restored LSA flow. Multidisciplinary endovascular repair effectively addresses complex aortic and subclavian injuries. Ultra-short proximal landing zones (<2 mm) require precise stent deployment and hybrid revascularization. This case underscores the feasibility of endovascular repair in anatomically hostile trauma settings and highlights technical strategies that can guide management of similar complex injuries in young patients.

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