On a whole-body CT of a polytrauma patient, an aortic injury at the isthmus shows a contained pseudoaneurysm with periaortic haematoma. According to current guidelines, which is the preferred management?

• A Open surgical aortic repair within 6 hours
• B Medical management alone with anti-impulse therapy
• C Thoracic endovascular aortic repair (TEVAR) ✓
• D Repeat CT at 24 hours to assess progression

Explanation

Traumatic thoracic aortic injury at the isthmus (most common site due to ligamentum arteriosum fixation) with a contained pseudoaneurysm is now managed by TEVAR as the first-line approach. TEVAR offers lower mortality and paraplegia rates compared to open surgery in trauma patients. Medical management alone is insufficient for contained pseudoaneurysm. Immediate open repair carries unacceptably high morbidity in polytrauma. Watchful waiting with CT is appropriate only for minimal aortic injury (intimal tear <1 cm, no haematoma).

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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