Traumatic Aortic Isthmus Rupture in A Polytrauma Patient Treated by Thoracic Endovascular Repair with Left Subclavian Artery Fenestration: A Case Report

¹A. Bahaddi,²S.Bousseaden,³MA. Fehdi,⁴A.Dafir,⁵B.Aggoug,⁶M.Mouhaoui

^1,2,3,4,5,6Service des urgences Trauma Center, CHU Ibn Rochd, Casablanca, Morocco

DOI: 10.58806/ijhmr.2026.v5i3n03

ABSTRACT

Blunt traumatic injury of the thoracic aorta represents a rare but highly lethal condition, most frequently resulting from high-energy deceleration mechanisms such as road traffic accidents. Up to 80% of patients die before reaching hospital care. Among survivors, the aortic isthmus is the most commonly affected segment due to biomechanical stress at the junction between the mobile ascending aorta and the fixed descending thoracic aorta.
Computed tomography angiography (CTA) is the diagnostic modality of choice, allowing rapid identification of aortic lesions and associated injuries in polytrauma patients. Over the past two decades, thoracic endovascular aortic repair (TEVAR) has replaced open surgery as the first-line treatment, offering significantly reduced perioperative mortality and neurological complications.
However, endovascular repair of aortic isthmus injuries often necessitates coverage of the left subclavian artery (LSA), potentially increasing the risk of ischemic complications. Various strategies for LSA preservation have been described. In emergency settings, endovascular fenestration represents a valuable alternative. We report a case illustrating this approach.

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