Longitudinal Anesthetic and Critical Care Management After Emergency Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury in an Adolescent: A Case Report

Blunt thoracic aortic injury (BTAI) is uncommon in children and adolescents but carries substantial early mortality.Thoracic endovascular aortic repair (TEVAR) can provide rapid definitive control in anatomically suitable patients; however, the subsequent course is often driven by associated injuries and evolving critical illness.A previously healthy 14-year-old boy was transferred after a high-energy road traffic collision with a contained injury of the descending thoracic aorta, mediastinal hematoma, left femoral and open tibial fractures, pulmonary contusions, and splenic contusion.Emergency TEVAR with a 24 × 80-mm thoracic endograft achieved complete exclusion without endoleak.External fixation of the long-bone fractures followed.After initial extubation, the patient required reintubation on hospital day 4 for severe hypoxemia with bilateral pulmonary consolidations and left pleural effusion; he was successfully extubated two days later.On day 21, delayed ileocecal perforation with diffuse peritonitis required emergency right hemicolectomy.Definitive femoral and tibial intramedullary fixation and pleural drainage were performed on day 35, followed by percutaneous drainage of a pelvic abscess on day 44.He was discharged home neurologically intact on day 50, with a patent, well-positioned endograft and no endoleak.This case shows that successful TEVAR is one component of a prolonged, physiology-driven perioperative strategy requiring continuity across vascular, orthopedic, abdominal, respiratory, and rehabilitation care.