NON-FATAL PSEUDOANEURYSMS OF THE DESCENDING THORACIC AORTA AFTER SHRAPNEL INJURY: HYBRID AND ENDOVASCULAR TREATMENT

 

INTRODUCTION. Penetrating thoracic trauma caused by shrapnel injuries represents a rare but significant mechanism of non-fatal vascular insult, often resulting in pseudoaneurysm (PSA) formation of the descending thoracic aorta. These lesions pose a high risk of delayed complications, particularly aortoesophageal fistula (AEF), which can be life-threatening. The potential for infection due to retained foreign bodies further complicates clinical management and long-term outcomes. With the advent of thoracic endovascular aortic repair (TEVAR), less invasive strategies have become the preferred treatment modality. However, concerns remain regarding endograft infection and the optimal duration of antimicrobial therapy in this unique patient population. 

OBJECTIVE. To evaluate early and midterm outcomes after descending TEVAR for nonfatal post-shrapnel pseudoaneurysms of the descending aorta and to analyze the correlation between antibiotic therapy duration and early CT signs of endograft infection, particularly concerning aortoesophageal fistula formation.

CONCLUSION. Non-fatal post-shrapnel aortic injuries are potentially infected and associated with a high risk of aortic PSA formation with AEF complications. CTA remains the “gold standard” for diagnosing and TEVAR – for non-fatal post-shrapnel PSA treatment.

KEYWORDS. Descending thoracic aorta, pseudoaneurysm, shrapnel injury, thoracic endovascular aortic repair (TEVAR), aortoesophageal fistula (AEF), endograft infection, computed tomography angiography (CTA), vascular trauma, penetrating chest injury, antibiotic therapy duration.