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Delayed Presentation Of Blunt Abdominal Aortic Injury; A Rare Injury Managed With Endovascular Aortic Repair
Jacob Wilson, DO, Martin Lo Sasso, MD, Michael Qaqish, MD, Lynne Doctor, MD, Sharvil Sheht, MD.
St. Luke's University Health Network, Bethlehem, PA, USA.

Demographics: 40 year old African American MaleHistory: The patient suffered a fall down stairs with extreme hyperextension of his back. He presented to an outside hospital and underwent evaluation with a CT scan of chest, abdomen, and pelvis without contrast enhancement. Primary survey revealed no definite injuries. Imaging demonstrated peri-aortic fat stranding near the aortic bifurcation but no aneurysm, hematoma, or disruption. He was discharged to home. He presented to our institution 10 days after the injury for evaluation of back pain with lower extremity paresthesias. A CTA of abdomen and pelvis revealed a 3.4cm aortic bifurcation pseudoaneurysm (Fig 1).Plan: The patent underwent urgent endovascular aortic repair with a Gore Excluder bifurcated graft with technical success. After lumbar spine MRI, he was discharged to home on POD #3 with no major complications, full recovery, and on anti-platelet therapy. Short interval imaging showed a durable repair.DiscussionBlunt abdominal aortic injury (BAAI) is rare, comprising only 5% of blunt aortic injury reported in the literature with a high pre-hospital and in hospital mortality. Often BAAI presents immediately with concomitant lumbar fractures due to high energy mechanisms. The low energy mechanism of injury and delayed presentation to our hospital system demonstrates how BAAI can progress. Unfortunately, the index CT scan is without contrast and therefore we cannot accurately diagnosis the initial injury. The patient presented to our system with a Zone 3 (infra-renal) Blunt Abdominal Aortic Grade 3 injury (pseudoaneurysm) based on classifications defined by Starnes et Al, Shalhub et Al. This case demonstrates the importance of appropriate imaging and surveillance of BAAI. It offers insight into how an isolated aortic injury can evolve into a pseudoaneurysm in a short period of time. An endovascular aortic repair with a bifurcated Gore Excluder graft offered a safe and definitive repair.



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