Subclavian-to-carotid transposition and supracarotid endovascular stent graft placement for traumatic aortic disruption

Technologic advances in delivery systems and imaging have allowed expansion of endovascular surgery indications to include the treatment of thoracic aortic disease. Delayed exclusion of traumatic proximal aortic disruption has been shown to be technically feasible, with a low risk of false aneurysm rupture. Long-term endovascular exclusion of these lesions may be precluded by the short or poor quality neck available below the origin of the left subclavian artery for graft fixation. A case report of a traumatic aortic disruption treated with staged subclavian-to-carotid transposition and subsequent endograft fixation is presented. The uncovered bare wire portion of the stent was placed across the left carotid artery. One-year follow-up demonstrated complete exclusion of the false aneurysm, with stable graft fixation, and no neurologic deficits. This technique may provide a means whereby proximal aortic pathology is safely excluded without regard to the length or quality of juxtasubclavian neck available for fixation.