Tratamiento de trauma aórtico grado II asociado a origen de arteria vertebral izquierda de arco aórtico

Dr. Luis Raúl Sandoval Alfaro
Médico especialista en Cirugía Vascular Periférico.
Hospital de Ciudad Neily, San José, Costa Rica.

Dr. José Alejandro Chaves Gómez
Médico especialista en Cirugía Vascular Periférico.
Hospital México, San José, Costa Rica.

Dr. José David Brenes Gutiérrez
Médico especialista en Cirugía Vascular Periférico.
Hospital México, San José, Costa Rica.

Dra. Ana Laura Sandoval Alfaro
Médico General.
San José, Costa Rica.

Resumen

El trauma aórtico contuso es una condición grave que se puede presentar hasta en el 33 % de las muertes por accidentes de tránsito. Se describe el caso de una mujer de 60 años con historia de 8 días de accidente automovilístico, en el que salió expulsada del vehículo aproximadamente 2 metros. Presentó múltiples fracturas costales y fractura de C7 que requirió inmovilización cervical. Durante la hospitalización, se documenta hemotórax izquierdo, por lo que se realiza angiotomografía axial computarizada, donde se documenta lesión aórtica tipo II a 8 mm del origen de la arteria subclavia izquierda y, además, de emergencia de la arteria vertebral izquierda del arco aórtico. Se realiza intervención aórtica endovascular torácica junto a chimenea hacia la arteria subclavia izquierda y embolización de arteria vertebral izquierda como resultado de exclusión completa de lesión aórtica.

Palabras claves

Trauma, aorta, endoprótesis, TEVAR, chimenea.

Abstract

Blunt thoracic aortic injury is a serious condition that can occur in up to 33 % of the deaths in road traffic accidents. We describe the case of a 60-year-old woman with an 8-day history of a car accident, expelled from the vehicle approximately 2 meters. She had multiple rib fractures and C7 fracture that required cervical immobilization. During hospitalization, they found a mediastinal widening associated with a left hemothorax. The results of an emergent computed tomography angiography (CTA) demonstrated a type II aortic injury that has 8 mm of proximal sealing from the origin of the left subclavian artery, we also documented that the left vertebral artery originates directly from the aortic arch. Endovascular aortic intervention is performed with a C-TAG Active Control and a single chimney to the left subclavian artery and embolization of the left vertebral artery with exclusion of the aortic injury.

Keywords

Trauma, aorta, endograft, TEVAR, chimney.

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