Introduction: South Africa is considered one of the trauma capitals of the world, with its trauma facilities experiencing an overwhelming number of patients daily. These range from stab wounds and gunshot wounds from interpersonal conflicts to motor vehicle accidents, to name a few. Although vascular injuries to extremities are common and usually minor, injury to major thoracic vessels is not as common. We present 2 cases of thoracic major vessel injuries managed endovascularly at our institution. Both cases were managed successfully and have been discharged

Case report: The first patient is a 13-year-old male patient who sustained a knife injury to the descending thoracic aorta. He presented hemodynamically stable, and the injury was confirmed on a CT scan, with no other obvious injuries. The patient was then taken to the angiosuite for endovascular repair. A covered Endurant II 24mm x 82mm iliac limb stent graft was deployed with simultaneous removal of the knife. The patient recovered well, and there were no complications on subsequent follow ups. The second patient is a 38-year-old male patient who suffered an anterior chest wall stab wound following an attempted robbery. He presented hemodynamically stable with an impaled knife, complaining only of chest pain. The patient was taken straight to the angiosuite without cross-sectional imaging. An injury to the left brachiocephalic vein was seen, and balloon tamponade was used after removal of the knife. The patient recovered well and did not complain of pain post operatively.

Discussion: Although the standard of care is open surgery for major thoracic vascular injuries in trauma, endovascular approaches are gaining traction. The advantage of endovascular approaches is the reduced morbidity and mortality associated with open surgery. Ideally, these procedures should be performed in a hybrid theater where conversion to open surgery would not be delayed if needed. 

Lefa Shelile is a qualified general surgeon from the College of Medicine of South Africa. He is currently pursuing a qualification in vascular surgery at Sefako Makgatho Health Science University in Pretoria, South Africa. He has publications in journals such as the Journal of Vascular Surgery Cases, Innovations and Techniques, and the South African Journal of Surgery. He is also active in peer reviews, acting as a reviewer for AME, where he contributes to improving scientific publications. He is currently the vice president of the South African Society of Surgeons in training. He has a passion for minimally invasive surgical techniques, including endovascular techniques in vascular surgery. He has presented at multiple conferences across South Africa, including, Surgical Research Society, the Surgical updates conference, and the Vascular Society of Southern Africa, to name a few.