Abstract
A 70-year-old man was transferred to our hospital with unstable vital signs and an APACHE III score of 47. Multidetector-row computed tomography (MDCT) detected acute aortic dissection, accompanied with bilateral hemothorax, thoracic vertebral fracture, and subarachnoid hemorrhage. The aortic dissection was immediately treated by transluminally placed endovascular grafting (TPEG), which covered the level Th-5 to -12 of the thoracic aorta. Right thoracotomy was made to coagulate the pleural bleeding due to the vertebral fracture, which aggravated the right hemothorax even after TPEG. The postoperative course was uneventful and there was no paraplegia. The patient was discharged on the 44th postoperative day. Postoperative computed tomography confirmed disappearance of the subarachnoid hemorrhage and the hemothorax, and successful placement of the stent-graft with spared patency of the celiac artery. Not only was it feasible for the whole body examination for other trauma, MDCT enabled precise preoperative planning for the emergency TPEG. Since blunt aortic injury is frequently accompanied by multiple trauma, TPEG could treat the complicated conditions less invasively, with a minimal amount of preprocedural anticoagulant for the aortic surgery, and with a reduced volume of blood loss.
