Canadian Journal of Anesthesia 51:931 (2004)
© Canadian Anesthesiologists' Society, 2004
Cardiothoracic Anesthesia, Respiration and Airway
Images in Anesthesia: Transesophageal echocardiography enhances endovascular stent placement in traumatic trans-section of the thoracic aorta
Gary Dobson, MD CM FRCPC,
Paul Petrasek, MD FRCPS and
Nanette Alvarez, MD FRCPC
Calgary, Alberta
A 19-yr-old male presented for endovascular stenting of a traumatic trans-section of his thoracic aorta. Following induction of general anesthesia, transesophageal echocardiography (TEE) was performed to monitor stent placement and to ensure that the pseudoaneurysm was isolated. The pseudoaneurysm was readily identified just distal to the left subclavian artery, with the guide wire passing into the aortic arch (Figure 1
). The stent’s introducer was difficult to position and tended to enter the orifice to the false aneurysm (Figure 2; video available as Additional Material at cja-jca.org). This was not apparent on fluoroscopy.
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FIGURE 1 The long axis view of the descending thoracic aorta with the pseudoaneurysm (A) along the posterior wall and the guide wire (B) extending towards the aortic arch.
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The use of endovascular stenting in the treatment of traumatic disruption of the thoracic aorta is increasing.1,2 TEE is currently used in this setting to evaluate the landing zone and identify endo-leaks.3 This case illustrates the use of TEE in preventing the unintentional entry of the stent introducer into the pseudoaneurysm, with potential disruption of a contained aortic trans-section.
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References
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1 Marty-Ane CH, Berthet JP, Branchereau P, Mary H, Alric P. Endovascular repair for acute traumatic rupture of the thoracic aorta. Ann Thorac Surg 2003; 75: 1803–7.[Abstract/Free Full Text]
2 Sam A II, Kibbe M, Matsumura J, Eskandari MK. Blunt traumatic aortic transection: endoluminal repair with commercially available aortic cuffs. J Vasc Surg 2003; 38: 1132–5.[Medline]
3 Swaminathan M, Lineberger CK, McCann RL, Mathew JP. The importance of intraoperative transesophageal echocardiography in endovascular repair of thoracic aortic aneurysms. Anesth Analg 2003; 97: 1566–72.[Abstract/Free Full Text]
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