One size does not fit all: Case report of two percutaneous closures of aortic pseudoaneurysm and review of the literature

Percutaneous closure of a large ascending aortic pseudoaneurysm

“…2---6 Experience with percutaneous closure of aortic pseudoaneurysms has increased steadily since the introduction of the technique in 2005, with several benefits, including fewer potential complications and avoidance of surgical risk. 6 In this case, despite all the technical difficulties, the procedure had both imaging and clinical success, rendering the patient asymptomatic and without events in a follow-up of over one year.…”

“…6 Clinical presentation ranges from completely asymptomatic for years to symptoms related to the mass effect on surrounding structures. 6 If left untreated, aortic pseudoaneurysms can evolve to rupture, thrombosis, distal embolization and fistula formation, with high mortality (up to 61%). 6 Surgical repair of this complication is the conventional treatment, but it is associated with very high morbidity and mortality (mortality can reach 46%) and in some cases is not even feasible (due to the technical difficulties in patients who have undergone prior complex thoracic surgeries), so percutaneous closure has been described as an alternative.…”

“…6 If left untreated, aortic pseudoaneurysms can evolve to rupture, thrombosis, distal embolization and fistula formation, with high mortality (up to 61%). 6 Surgical repair of this complication is the conventional treatment, but it is associated with very high morbidity and mortality (mortality can reach 46%) and in some cases is not even feasible (due to the technical difficulties in patients who have undergone prior complex thoracic surgeries), so percutaneous closure has been described as an alternative. 1---6 In the past, several percutaneous techniques for closure of a pseudoaneurysm have been attempted such as stent grafting, coil implantation or thrombin injection, but the final results obtained were suboptimal.…”

“…2---4,6 Overall, the success rate for percutaneous closure is 80%, with a 12% device embolization rate and an 8% failure rate of the transcatheter technique to close the pseudoaneurysm, necessitating conversion to surgical closure. 5,6 We present a case in which a symptomatic large pseudoaneurysm of the ascending aorta was treated percutaneously due to the patient's high surgical risk.…”

Endovascular closure of thoracic aortic pseudoaneurysms: A combined device occlusion and coil embolization technique in patients unsuitable for surgery or stenting

“…However, the deployment of stent grafts is not always possible in every case and is dependent on the patient's specific anatomy and pathology. In addition, there have been numerous reports on the off‐label application of septal occluder devices and vascular plugs to occlude the necks of APAs , with the largest published series being 6 patients . In our previous case report, one of the APAs was treated with both coils and a septal occluder to the neck of the APA.…”