Endovascular treatment of a ruptured post-traumatic false aneurysm of the aortic isthmus: A case report

The false aneurysm of the aortic isthmus is, given its severity and case fatality rate, a subject of interest in vascular surgery. The interest of this article is the analysis of the different characteristics of this pathology based on the study of a case report and on a review of the literature. This is a 21-year-old patient admitted for the management of a severe polytrauma following a fall from a cliff, causing him paraplegia following a fracture of the dorsal spine which is objectified on the CT bodyscan, which also shows the presence of a localized dissection with ruptured false aneurysm of the isthmus. After emergency conditioning and initial neurosurgical management by vertebral osteosynthesis, the postoperative effects are aggravated by the occurrence of a bilateral massive pulmonary embolism. Thus, given the high risk of complications or death following classic thoracotomy surgery, we decided to carry out endovascular treatment by placing a covered endoprosthesis. The aortic isthmus false aneurysm is a relatively rare condition that mainly interests the young subject in an often-post-traumatic context. The surgical treatment represented by thoracotomy, which, in addition to being invasive, exposes the patient to multiple complications as disabling as each other. All of these elements explain the advantage of endovascular treatment, which is much less invasive with a better prognosis. The therapeutic management of a pseudoaneurysm of the isthmus is undergoing constant development; endoprostheses currently occupy the place of choice in the treatment of these lesions. •The aortic isthmus false aneurysm is, due to its severity, and case fatality rate a topic of interest in vascular surgery.•Rupture of the isthmus occurs especially in young male subjects, in a post-traumatic context.•High risk of complications or death following classic thoracotomy surgery.•Endovascular treatmentis less invasive, with less risks of thoracotomy.