A Damage-Control Strategy With Immediate Thoracic Endovascular Aortic Repair (TEVAR) for Polytrauma With Blunt Thoracic Aortic Injury and Intra-abdominal Hemorrhage: A Case Report

We report the case of a man in his 70s who sustained polytrauma in a motor vehicle collision and presented in profound hemorrhagic shock. Focused assessment with sonography for trauma was positive for intra-abdominal fluid, and chest radiography demonstrated marked mediastinal widening. After endotracheal intubation and emergency transfusion, contrast-enhanced computed tomography revealed hemoperitoneum due to severe splenic hilar injury and blunt thoracic aortic injury with aneurysmal morphology and subadventitial hematoma, raising concern for impending rupture. Because both lesions were potentially fatal and endovascular repair required preparation time, a damage-control strategy was adopted. The patient underwent emergency laparotomy with splenectomy, distal pancreatectomy, and temporary abdominal closure for abdominal hemorrhage control, followed immediately by thoracic endovascular aortic repair. The abdomen was definitively closed on hospital day 3, and the postoperative course was uneventful. The patient was discharged home on hospital day 39. This case highlights that, in selected patients with polytrauma and unstable thoracic aortic morphology, the key issue is not only whether thoracic endovascular aortic repair is indicated, but how hemorrhage control, aortic exclusion, and resuscitation should be sequenced without avoidable delay. Incorporating thoracic endovascular aortic repair into damage-control care may be effective when supported by rapid multidisciplinary decision-making, parallel preparation, and strict hemodynamic management.