Endovascular repair of ascending aorta pseudoaneurysm

Abstract

We present a case of a 48-year-old female patient with Marfan syndrome and previous open surgeries for Bentall procedure and arch replacement with frozen elephant trunk (FET) technique, who was admitted at our Department with a diagnosis of ascending aorta pseudoaneurysm at the anastomosis-site between composite valve graft and arch prosthesis treated by endovascular procedure because of she was considered to be at high-risk for a third open surgery and for the patient's favorable anatomy for endovascular closure of the pseudoaneurysm. The patient was successfully treated with the positioning of two abdominal cuffs through the left axillary artery. The postoperative course was uneventful and at 2-month follow-up, the patient was free of complications with CT angiogram showing complete endovascular exclusion of the pseudoaneurysm.

Percutaneous endovascular management of ascending aortic pseudoaneurysm after heart transplantation in a pediatric patient

“…However, some authors have proposed alternatives in high‐risk surgical patients such as atrial septal defect occluder, vascular plugs, stents, coil embolization, and thrombin injection with favorable reported outcomes 3‐5 . Endovascular management is less aggressive and is associated with less blood loss and shorter procedural time 3,4 . Our case was considered a high‐risk patient because of his immunosuppression condition, a prior severe systemic infection, and graft rejection.…”

“…In the literature, most patients with a heart transplant history were treated by surgery 8,12,13 . However, some authors have proposed alternatives in high‐risk surgical patients such as atrial septal defect occluder, vascular plugs, stents, coil embolization, and thrombin injection with favorable reported outcomes 3‐5 . Endovascular management is less aggressive and is associated with less blood loss and shorter procedural time 3,4 .…”

“…The most conventional management is surgery 3 . Some authors had proposed alternative options such as grafts, vascular plugs, stents, coil embolization, and thrombin injections 3‐5 . We report the case of a ten‐year‐old male who had a pseudoaneurysm of ascending aorta after orthotopic HT and was treated successfully with endovascular stents placement.…”

“…Some predisposing factors are leakage by cannulation sites, suture lines, aortic grafts anastomosis, and infections 2 . The most conventional management is surgery 3 . Some authors had proposed alternative options such as grafts, vascular plugs, stents, coil embolization, and thrombin injections 3‐5 .…”

Staged treatments of multiple pseudoaneurysms after total arch replacement

“…The risk of complications of endovascular treatments, such as endoleaks or stent‐graft deviations, is unavoidable. Di Marco et al reported endovascular repair of an ascending aortic pseudoaneurysm with considerations that TEVAR of the ascending aorta requires debranching technique or a short device designed with a short sheath that cannot reach the ascending aorta from the femoral access. The particular location of the ascending aortic pseudoaneurysm directly affects the cardiac output, and the risk of complications, such as endoleaks, stent‐graft migration, myocardial infarction, and devise deployment failure, remains high.…”