Endovascular treatment of the descending thoracic aorta in a patient with a hydatid pseudoaneurysm

Abstract

We present a patient affected by systemic hydatidosis with an unusual localization in the thoracic aorta. The pseudoaneurysm, which was treated 8 years ago with conventional surgery, was retreated with an endovascular procedure. The particular evolution of the pathology needed further endovascular intervention. Endovascular exclusion is not the final solution of the disease but protects against rupture of the vessel and systemic dissemination of the disease.

Hydatid cyst of the middle mediastinum complicated by fistulated ascending aorta: A case report and review of the literature

“…Previous case reports noted chest pain, recurrent arterial embolic events, and even asymptomatic presentation. 7 , 8 , 9 Preoperative diagnosis of extrahepatic and pulmonary hydatid cysts is challenging, even in endemic areas, unless there is a specific consideration for a hydatid cyst. Previous studies recommended that digital subtraction angiography, CT scan, MRI, and ultrasound as effective approaches for detecting the exact relation of cysts and aorta walls in thoracic and aortic hydatid cysts.…”

“…Hydatid cysts that involve the aorta were reported with different clinical presentations based on the hydatid cyst location, extension, and complications. Previous case reports noted chest pain, recurrent arterial embolic events, and even asymptomatic presentation 7–9 . Preoperative diagnosis of extrahepatic and pulmonary hydatid cysts is challenging, even in endemic areas, unless there is a specific consideration for a hydatid cyst.…”

Hydatid disease with pseudo-aneurysm formation of the descending thoracic aorta: a case report

“…Some authors suggest hydatid cysts in adjacent tissues being the cause of erosion of arterial wall, and some believe that the parasite localizes primarily in the aortic wall, in such cases with coexisting aneurysm or an endothelium defect in the vessel. 6 Others propose that the arrival of the parasite in the vessel is via the vasa vasorum. 7 There is as yet no definitive surgical treatment for arterial hydatidosis due to the rarity of this disease.…”

Primary Hydatid Cyst of the Thoracic Aorta Revealed by Peripheral Arterial Embolism

“…Magnetic resonance imaging can show the interaction between the cyst and the aorta and detect altered blood flow. Further exploration by angiography is useful to define possible communications between the cyst and the aortic lumen [6].…”

“…Cardiopulmonary bypass is necessary to avoid systemic and peripheral dissemination of hydatid membranes, especially in cardiac hydatidosis or proximal aortic involvement or when long aortic clamping is necessary [7]. Endovascular treatment, with placement of an endoprosthesis, was proposed by Volpe and associates [6] for aortic hydatid pseudoaneurysm with ataxia and motor deficit of the lower limbs secondary to extension toward vertebral bodies. Yet a risk of prosthesis migration with local recurrence exists mainly if the cyst has not been completely removed.…”