Focal Aortic Dissection With Significant Stenosis: A Rare Long Term Complication After TEVAR for Blunt Traumatic Aortic Injury in an Adolescent Patient

Thoracic endovascular aortic repair (TEVAR) in children and adolescents after blunt traumatic aortic injury (BTAI) is increasingly being performed, despite no endovascular graft being approved for TEVAR in this population. The smaller diameter of the aorta and access vessels and steeper angle of the aortic arch pose specific challenges in TEVAR in this population. Moreover, data are lacking regarding medium to long term complications. This case presents an adolescent patient who underwent TEVAR for BTAI and suffered a focal aortic dissection several months later. The patient initially presented after a motor vehicle accident and underwent an uncomplicated TEVAR procedure with a 28 mm diameter stent graft (the smallest device available at the time) for Grade III traumatic aortic dissection; the native aortic diameter was 15 mm. The diameter mismatch was accepted due to the lifesaving nature of the procedure. More than 7 months later the patient presented himself to the emergency department after not being able to urinate for several days and experiencing pain, tingling, and weakness in both legs. Blood samples showed a severe acute kidney injury and computed tomography angiography showed significant aortic stenosis in the distal part of the stent graft, likely caused by a focal dissection. The stenosis and dissection were successfully treated using a Palmaz stent, after which his renal function and extremity complaints recovered. The focal dissection was likely caused by stress on the aortic wall due to the aorta–stent graft diameter mismatch. This case demonstrates that complications after TEVAR in adolescents can arise months after the initial procedure and underscores the need for continued vigilance, especially in cases with an aorta–stent graft mismatch. The threshold for additional imaging and consultation by a vascular surgeon should be low. •Thoracic endovascular aortic repair (TEVAR) is increasingly being used in adolescents, but little is known about complications.•Focal aortic dissection is a possible complication after TEVAR in adolescents.•Focal aortic dissection can lead to renal failure and lower extremity ischaemia.•Risk of focal aortic dissection is possibly increased by aorta–stent graft mismatch.•The threshold for imaging should be low in adolescent patients after TEVAR for blunt traumatic aortic injury.