Endovascular Stent for Iatrogenic Penetrating Injury of the Thoracic Aorta

Vagefi et al reported, in their recent article, an interesting case of a 74-year-old woman affected by pericardial effusion and treated with percutaneous pericardiocentesis. The procedure was complicated by descending thoracic aorta penetrating injury repaired by an endovascular procedure: a 20-mm diameter 3.75-cm long Aneurx aortic cuff stentgraft (Medtronic Inc, Santa Rosa, California) was positioned. Pericardiocentesis was first conceptualized in the 17th century. It can be performed in the emergency setting for cardiac tamponade or on an elective basis for recurrent pericardial effusions. By relieving the excessive pressure these fluids impose on the heart, symptomatic patients can find instant relief, and life-threatening situations can be managed. Also, with echocardiographic guidance, which is now indicated for all elective procedures, the pericardiocentesis have minimal risk. The most frequent complications are cardiac muscle perforation (mainly right ventricle), cardiac arrhythmias, coronary arteries puncture (mainly right coronary artery), pneumothorax, right atrium puncture, pain after piercing the pericardium, hemothorax, arterial puncture (left internal thoracic artery), infection, stomach or colon penetration, and liver injury. To date, no cases of descending thoracic aorta puncture has been described. Congratulations to the authors for this rare and welldocumented case that shows how even a common procedure such as pericardiocentesis can hide many pitfalls. This case report confirms that the endovascular procedures are once again the treatment of choice for emergencies descending thoracic aorta.