A Race Against Time: Collaborative Emergency and Cardiothoracic and Vascular Surgery–Led Endovascular Repair in Traumatic Aortic Transection with Polytrauma

Blunt traumatic aortic transection is one of the most lethal injuries following high-energy deceleration trauma. Early diagnosis, prompt haemodynamic stabilisation, and seamless coordination between emergency medicine and cardiothoracic and vascular surgery (CTVS) teams are critical to survival. A 38-year-old male presented to the emergency department after a high-velocity road traffic accident with multiple injuries, including a right femoral deformity and upper abdominal pain radiating to the back. The emergency physician initiated advanced trauma life support (ATLS)–based resuscitation and ordered urgent computed tomography (CT) polytrauma imaging, which revealed a contained rupture of the descending thoracic aorta, 4.5 cm distal to the left subclavian artery, associated with mediastinal haematoma compressing the oesophagus, mild haemopericardium, bilateral pulmonary contusions, and a comminuted right femoral fracture. Recognising the critical nature of the injury, the emergency team activated the multidisciplinary trauma protocol, involving the CTVS and orthopaedic teams. Following rapid stabilisation, thoracic endovascular aortic repair (TEVAR) using a Medtronic Endurant stent graft (24/24/100 mm) was performed through right femoral artery exposure, achieving immediate haemodynamic control. Subsequently, the patient underwent open reduction and internal fixation (ORIF) for the femur fracture. Postoperatively, mild hypoxaemia due to fat embolism was managed conservatively. The patient made a full recovery, maintaining stable haemodynamics and oxygenation at discharge. This case highlights how rapid emergency leadership and precise CTVS intervention can transform an otherwise fatal aortic transection into a survivable event. Early clinical suspicion, timely imaging, and multidisciplinary teamwork remain the cornerstones of modern trauma success.