Complete traumatic aortic transection

Abstract

Complete aortic transection is typically fatal and extremely rare in pediatric patients. High clinical suspicion, even in hemodynamically stable patients, is essential for timely recognition and intervention. There is scant literature on the management of complete aortic transection in pediatric patients. Retrospective chart review of an adolescent who survived a large complete thoracic aortic rupture along with systematic pediatric literature review. A 16-year old female presented with a complete thoracic aortic transection with a 5-6 cm gap after an auto-pedestrian collision. Mediastinal vascular injury was suspected based on presentation, confirmed by chest radiograph, and further delineated by computed tomography. CT angiography was critical in determining the anatomy of injury and planning repair. Repair was achieved by left heart bypass and Dacron interposition grafting. The patient survived without vascular-related complications and remains well at 3-year follow up. Literature review revealed scant data on the diagnosis and management of complete aortic transection in children. The role of selective imaging for diagnosis is warranted. The applicability of endovascular stent-grafting in pediatric patients remains uncertain.