Annals of vascular surgery
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Traumatic rupture of the aorta in the rare setting of the aberrant right subclavian artery (ARSA) requires special consideration to prevent the occurrence of a devastating posterior cerebral circulation stroke. We present three cases managed by using an endovascular approach, with a discussion of important preoperative and operative issues. Three patients involved in motor vehicle collisions with multiple injuries were managed at two institutions. ⋯ Although the incidence of ARSA is very low, preoperative imaging and assessment of cerebral blood flow are critical to prevent a perioperative stroke. Revascularization, if required to achieve a secure proximal landing zone, must be performed before endograft deployment. Bilateral subclavian revascularization is indicated if anomalies of the cerebral circulation are present.
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Aortic thrombus is a rare and a life-threatening consequence of aortic trauma. We report the case of a young man presenting with this complication after a motor vehicle accident, and in whom a large aortic thrombus was identified at the aortic isthmus by computed tomography of the chest. The lesion was treated initially with heparin, and a delayed covered stent was used for a false aneurysm of the aortic isthmus that was discovered secondarily.