Endovascular treatment of traumatic thoracic aortic injury—should this be the new standard of treatment?

A, A thoracic aortogram demonstrates a large aortic pseudoaneurysm caused by a blunt thoracic injury that occurred just distal to the left subclavian artery. B, Computed tomography angiography of the chest following successful endovascular pseudoaneurysm exclusion with a left carotid-to-subclavian bypass graft.²⁴

In the clinical situation of an oversized endograft placed in a small aorta with a tight aortic curvature, the device fails to appose the inner curvature. Infolding of the lower lip of the graft can occur with catastrophic consequences. This has not occurred when the device is sized according to the directions for use.