Abstract
A 32-year-old woman with depression was injured in a fall. On arrival, she was confused and in hemorrhagic shock. Whole-body contrast-enhanced computed tomography (CT) revealed multiple injuries, including a blunt thoracic aortic injury with a pseudoaneurysm (IIIa) and severe pelvic fractures (IIIc). Thoracic digital subtraction angiography (DSA) showed an anomalous common origin of the brachiocephalic and left common carotid arteries, and the left subclavian artery originating from the aortic arch. As usual, the brachiocephalic artery branched into the right subclavian and right common carotid arteries, and the vertebral arteries originated from the subclavian arteries. DSA showed that the thoracic aortic pseudoaneurysm extended distally without extravasation, with a short distance to the left subclavian artery. After ascertaining good flow in both vertebral arteries, we performed thoracic endovascular aortic repair (TEVAR), covering the left subclavian artery without revascularization to obtain an adequate proximal seal. Although the patient experienced temporary arm claudication, this gradually improved. In this case, covering the left subclavian artery without revascularization was successful. Covering the left subclavian artery without revascularization in TEVAR can be considered if there is good flow in both vertebral arteries.
