HYBRID MANAGEMENT OF A 13-YEAR-OLD BOY WITH A DESCENDING THORACIC AORTIC INJURY FROM AN IMPALED KNIFE lefa.shelile@gmail.com

 

HYBRID MANAGEMENT OF A 13-YEAR-OLD BOY WITH A DESCENDING THORACIC AORTIC INJURY FROM AN IMPALED KNIFE

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South Africa

Oral or Poster

Paediatric major thoracic vascular trauma is a rare occurrence, with the majority of cases being related to blunt trauma to the chest.

We present a case report of the hybrid management of a 13-year-old boy who was stabbed with a knife, resulting in an injury to the descending thoracic aorta. The patient was managed using a thoracic endovascular aortic repair technique (using a 24 mm × 82 mm iliac limb stent). There were no major complications encountered intraoperatively or postoperatively.

A left-sided modified Rutherford Morrison incision was made with access on the extraperitoneal external iliac artery because the common femoral arteries were of inadequate diameter to deliver the stent graft (the size of the common femoral artery on duplex ultrasound, using outer to outer calliper position, was 54 mm and the external iliac artery was 73 mm). A covered endovascular stent (Endurant II 24 mm × 82 mm iliac limb stent graft) was deployed through the abdominal wall, initially the proximal third first; the knife was then pulled out with simultaneous deployment of the distal aspect.

There is paucity of published data on the management of impalement or stab to the thoracic aorta in the paediatric population. The choice of how to treat this rare case was discussed fully, mainly pertaining to the choice between open repair and endovascular repair. More research on this topic is needed.