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Rinaldi et al. Vessel Plus 2024;8:21 https://dx.doi.org/10.20517/2574-1209.2023.65 Page 13 of 19

Figure 8. (A) Angio-CT scan of a patient with blunt traumatic aortic injury (bTAI) and aortic rupture at the isthmic level. (B) The patient
underwent TEVAR, which involved excluding the false aneurysm and intentionally covering the LSA.

rDTA - ruptured aneurysm of the descending thoracic aorta
A ruptured descending thoracic aortic aneurysm (rDTA) is a serious and potentially life-threatening
condition. If left untreated, it can lead to high mortality rates. Endovascular repair with TEVAR has
emerged as the preferred treatment approach for rDTA, when feasible. TEVAR involves the placement of a
stent graft within the diseased segment of the aorta, providing a new pathway for blood flow and sealing off
the rupture. This minimally invasive technique has shown favorable outcomes in terms of 30-day morbidity
and mortality rates compared to open surgical repair [Figure 9] .
[67]

TEVAR offers several advantages over open surgery;however, it is important to note that not all rDTA cases
are suitable for TEVAR, as the anatomical characteristics of the rupture and the patient's overall condition
must be carefully evaluated, and thus, in some cases, open surgical repair may still be necessary.

Management
Some of the most important considerations regarding the endovascular management of rDTA may be
summarized in the following key points: Stent-Graft Oversizing: Avoiding stent-graft oversizing of less than
15%-20% is crucial, especially in patients with hypotensive shock, to prevent potential under-sizing and
[68]
ensure optimal sealing .

Proximal Extension: In certain scenarios, achieving endovascular exclusion of the aneurysm may necessitate
proximal extension with coverage of the left subclavian artery (LSA). However, the decision to cover the
LSA remains contentious, and the necessity for revascularization should be meticulously assessed on a case-
by-case basis .
[69]