In Reply to: Re: Case 0298_11--Infrarenal abdominal aortic traumatic rupture: Treatment with endoluminal covered stent posted by Moni Stein on February 06, 1998 at 18:59:37:
Very interesting case. An eye opener and good craftsmanship. This case validates the theory of “Osseous pinch ” as opposed to rapid deceleration theory, as the mechanism of aortic rupture. This theory suggests that during the accdent aorta gets pinned between head of the left clavicle and spine and this produces aortic tear in its usual location not the motion of loose versus fixed part as generally believed. I suppose this patient must have been wearing one of those seatbelts without shoulder component or a very loose shoulder piece so that when she was thrown forward with over 10 G force her aorta got pinched between the belt and the upper endplate of L3.
During the deployment of the stent, I wonder if you considered saving IMA. For this you would have required to obtain a lateral aortogram to locate the origin of the IMA in relation to the tear. Your stent graft is 1/3 above and 2/3 below the tear. By reversing this ratio i.e. deploying 2/3 above and 1/3 below you might have had a small chance of saving the IMA if you thaought of saving it.