Endovascular approach to treat ascending aortic pseudoaneurysm in a patient with previous CABG and very high surgical risk

Abstract

Pseudoaneurysm of the ascending aorta is an uncommon pathology and a challenge in high-risk patients who undergo conventional surgery because of high operative morbidity and mortality. Endovascular exclusion of an aortic pseudoaneurysm using an endoprosthesis is a less invasive approach, but few such cases have been reported. Moreover, the use of this approach poses unique therapeutic challenges because there is no specific endoprosthesis for ascending aortic repair, particularly to treat patients with previous coronary artery bypass graft (CABG). We describe the case of a 74-year-old patient who had undergone CABG and later presented with an iatrogenic ascending aortic pseudoaneurysm that occurred during an angiography. This patient was at very high risk for surgical treatment and, therefore, an endovascular approach was adopted: percutaneous coronary intervention for the left main coronary artery, left anterior descending and left circumflex native coronary arteries followed by endovascular endoprosthesis deployment in the ascending aorta to exclude the pseudoaneurysm. Both procedures were successfully performed, and the patient was discharged without complications 4 days later. At 5 months' clinical follow-up, his clinical condition was good and he had no complications.

Endovascular Closure of Ascending Aortic Pseudoaneurysm With a Type II Amplatzer Vascular Plug

“…2 Several less invasive endovascular approaches for closure of these pseudoaneurysms have been reported, especially in surgical high-risk patients. [3][4][5][6] Our patient initially presented with an incidentally detected pseudoaneurysm of the ascending thoracic aorta, 25 years following aortic root repair and mAVR. At that time, coil embolization was performed with technically good result.…”

“…Several endovascular treatment options have been reported and include ascending aortic stent grafts, percutaneous coil embolization, direct thrombin injection, and off-label use of septal closure devices and vascular plugs. [3][4][5][6] We report a successful closure of a reopened, asymptomatic ascending aortic pseudoaneurysm with the off-label use of a type II Amplatzer vascular plug (AVP) in a patient 8 years after closure with coil embolization and 33 years after the initial cardiac surgery.…”

Endovascular Treatment of Ascending Aorta: The Last Frontier?

“…We have recently published a series of five clinical cases and described the technique in which the axillary artery was used to deliver the endograft for the treatment of different thoracic aortic diseases [9]. We also demonstrated the possibility of concomitant treatment of ascending aorta disease and coronary stent implantation [10,11].…”

Endovascular treatment of non-dissected ascending aorta disease: a systematic review

“…Two articles provided interesting data about 3 patients treated with ascending aorta endograft implantation combined with percutaneous coronary treatments [23,25]. Moreover, Allen et al [15] reported 1 patient with severe aortic valve stenosis and concomitant acute ascending aorta penetrating ulcer with tamponade.…”