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The male patient was the unrestrained driver involved in a single vehicle rollover accident. In addition to his closed-head injury and rib fractures, the patient was found on CT scan to have an aortic dissection just distal to the renal arteries and underwent open aortic grafting to repair it.
A blue loop illustrates the path of the dissection in the aortic intima.
The aortic graft sewn in place. The IMA was small and had poor back bleeding; it was the staff surgeon's decision to reimplant it in the graft.
Relatively few cases of isolated injury to the abdominal aorta following blunt trauma have been reported. Both open and endovascular repair have been described in the literature, and have had comparable results.
In this patient's case, we felt that the likelihood of having routine post-endovascular repair follow-up was highly unlikely, and that he would be best served with a definitive open repair. We also did not have the ability to obtain a good personal and family history regarding collagen vascular disease, though the patient was not Marfanoid in body habitus.
He recovered well from both the operation and from his other injuries and was discharged home on post-op day 10