Two cases of traumatic aortic isthmus pseudoaneurysm successfully managed with endovascular repair: Multidisciplinary critical care and anesthetic perspective

Blunt thoracic aortic injury (BTAI) is a rare but life-threatening consequence of high-energy trauma, most commonly involving the aortic isthmus. Contrast-enhanced computed tomography is essential for rapid diagnosis and therapeutic planning. Thoracic endovascular aortic repair (TEVAR) has become the preferred treatment in hemodynamically stable patients because of its lower perioperative morbidity compared with open surgery. We report 2 cases of traumatic aortic isthmus pseudoaneurysm successfully treated with emergency TEVAR. A 34-year-old male motorcyclist presented with a 31 × 28 mm isthmic pseudoaneurysm associated with bilateral hemothorax and pulmonary contusions. A 17-year-old male sustained a 23 × 38 mm saccular pseudoaneurysm with pneumothorax following a similar mechanism of injury. Both patients underwent urgent TEVAR under general anesthesia using percutaneous femoral access; in the second case, adjunctive left subclavian artery stenting was required due to lesion proximity to the supra-aortic branches. Postoperative intensive care management included close hemodynamic and respiratory monitoring. These cases underscore the importance of rapid imaging, multidisciplinary coordination, and comprehensive perioperative management including anesthetic planning and critical care monitoring in the successful early management of BTAI. In our 2 patients, emergency TEVAR was associated with favorable early clinical outcomes, supporting its feasibility as part of a multidisciplinary treatment strategy in appropriately selected cases.