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Although initially haemodynamically stable, she developed airway compromise and underwent emergent open tracheostomy in a hybrid operating room. Thoracic endovascular aortic repair excluded the pseudoaneurysm and achieved hemorrhage control, after which the screwdriver was removed under controlled conditions. Her postoperative course was notable for transient atrial fibrillation and a duodenal bulb ulcer bleed, both managed appropriately. She was discharged home on postoperative day 19. Early airway control, endovascular hemorrhage control before extraction and multidisciplinary hybrid-operating room (OR) capability were key to survival.<\/jats:p>","DOI":"10.1136\/bcr-2025-269823","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T13:23:44Z","timestamp":1782912224000},"page":"e269823","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cervicothoracic screwdriver impalement causing traumatic aortic injury managed with TEVAR"],"prefix":"10.1136","volume":"19","author":[{"given":"Malena","family":"Allbright","sequence":"first","affiliation":[{"name":"Albany Medical College, Albany, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Divya","family":"Mohanraj","sequence":"additional","affiliation":[{"name":"Albany Medical College, Albany, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheetal","family":"Bapu","sequence":"additional","affiliation":[{"name":"Albany Medical College, Albany, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Albany Medical Center, Albany, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"2026090306050747000_19.7.e269823.1","doi-asserted-by":"crossref","DOI":"10.1136\/tsaco-2024-001619","article-title":"Penetrating neck trauma: a comprehensive review","volume":"10","author":"Loss","year":"2025","journal-title":"Trauma Surg Acute Care Open"},{"key":"2026090306050747000_19.7.e269823.2","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.jss.2022.11.077","article-title":"Nationwide Analysis of Penetrating Thoracic Aortic Injury: Injury Patterns, Management, and Outcomes","volume":"284","author":"Slocum","year":"2023","journal-title":"J Surg Res"},{"key":"2026090306050747000_19.7.e269823.3","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.avsg.2025.01.011","article-title":"Thoracic Endovascular Aortic Repair for Penetrating Aortic Trauma","volume":"113","author":"Zambetti","year":"2025","journal-title":"Ann Vasc Surg"},{"key":"2026090306050747000_19.7.e269823.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2010.08.027"},{"key":"2026090306050747000_19.7.e269823.5","doi-asserted-by":"crossref","DOI":"10.3389\/fsurg.2023.1264558","article-title":"Case report: Endovascular stent-graft repair of aortic penetrating trauma, literature review, and case report","volume":"10","author":"Bayona","year":"2023","journal-title":"Front Surg"},{"key":"2026090306050747000_19.7.e269823.6","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1097\/TA.0000000000004853","article-title":"Western Trauma Association critical decisions in trauma: Penetrating thoracic injury","volume":"100","author":"Lorenzo","year":"2026","journal-title":"J Trauma Acute Care Surg"},{"key":"2026090306050747000_19.7.e269823.7","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001106"},{"key":"2026090306050747000_19.7.e269823.8","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1002\/bjs5.50282","article-title":"Correlation between the level of the external wound and the internal injury in penetrating neck injury does not favour an initial zonal management approach","volume":"4","author":"Madsen","year":"2020","journal-title":"BJS Open"},{"key":"2026090306050747000_19.7.e269823.9","doi-asserted-by":"crossref","first-page":"e358","DOI":"10.1177\/000313481908500717","article-title":"Impalement at Zone I of Neck Causing Traumatic Subclavian Arterial Compression Injury","volume":"85","author":"Gogna","year":"2019","journal-title":"Am Surg"},{"key":"2026090306050747000_19.7.e269823.10","doi-asserted-by":"crossref","unstructured":"Feliciano DV . Penetrating Cervical Trauma. \"Current Concepts in Penetrating Trauma\", IATSIC Symposium, International Surgical Society, Helsinki, Finland, August 25-29, 2013. 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