Surgical treatment of pseudoaneurysm of the thoracic aorta

Atik, Fernando Antibas; Navia, José L.; Svensson, Lars; Vega, Pablo Ruda; Feng, Jingyuan; Brizzio, Mariano E.; Gillinov, A. Marc; Pettersson, Billie; Blackstone, Eugene H.; Lytle, Bruce W.

doi:10.1016/j.jtcvs.2006.03.052

Cited by 138 publications

(129 citation statements)

References 24 publications

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“…Various mechanisms for the formation of false aneurysm have been reported, including infection, poor anastomotic technique during surgery and intrinsic aortic wall disease. [1][2] However, site from the false lumen was lower than the actual aortic blood pressure. In our case, the patient might have had favorable conditions for the formation of a false aneurysm.…”

Section: Case Reportmentioning

confidence: 91%

Ascending Aortic False Aneurysm Formation Associated with Rupture of Acute Type A Aortic Dissection

Yamane

Mukai

Morimoto

et al. 2015

Annals of Vascular Diseases

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A 63-year-old man with ruptured acute type A aortic dissection was referred to our hospital. Computed tomography showed a false aneurysm arising from the false lumen located beside the ascending aorta. His hemodynamic status was stable inspite of the ruptured acute aortic dissection. We consider that the containment of the false aneurysm by thin mediastinal structures prevented worsening of his hemodynamic status, and this is extremely rare.Keywords: aneurysm, aortic dissection, aortic operation surgery. When he arrived at our hospital, his hemodynamic status was stable, his blood pressure was 110/78 mmHg and his heart rate was 78 beats/min (regular). CT fi lms from the referring hospital showed pericardial effusion and a ruptured type A aortic dissection with a primary entry tear in the distal aortic arch (Fig. 1A). In addition, there was a false aneurysm arising from the false lumen that was enhanced in the early phase (Fig. 1B). The false aneurysm was located beside the ascending aorta and expanding into the transverse sinus (Fig. 1C, D). We performed an emergency operation. After median sternotomy, the pericardial cavity was found to be fi lled with old blood, and there was no pericardial adhesion. Total cardiopulmonary bypass was initiated with retrograde perfusion through the femoral artery and bicaval venous drainage with left ventricular venting. After antegrade cold blood cardioplegia was selectively administered, cardiac arrest was obtained. However we could not fi nd the tear of adventitia which had caused the false aneurysm, we could identify the false aneurysm surrounded by connective tissue and hematoma. We thought that the tear of adventitia was located in the ascending aorta because adventitia of the aortic root was not ruptured. The transected proximal stump of the ascending aorta was reconstructed with both inner and outer Tefl on felt. He was cooled to 28°C, the ascending aorta was opened and selective antegrade cerebral perfusion was established. We performed total arch replacement using Dacron graft. Thoracic endovascular aortic repair was performed to close the primary entry 12 days after the surgery. The false aneurysm was not seen on the postoperative CT (Fig. 2), and his postoperative course was satisfactory. DiscussionFalse aneurysm is a rare and life threatening complication that occurs in 0.5% of all cardiac surgical cases. 2) False aneurysm of the thoracic aorta results from transmural disruption of the aortic wall and is contained by the surrounding mediastinal structures. When the pressure in the

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Section: Case Reportmentioning

confidence: 91%

Ascending Aortic False Aneurysm Formation Associated with Rupture of Acute Type A Aortic Dissection

Yamane

Mukai

Morimoto

et al. 2015

Annals of Vascular Diseases

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“…Pseudoaneurym of the ascending aorta can also manifest itself as a pulsatile mass, a peripheral embolism, aortic regurgitation, mediastinitis, or sepsis. 3 Pseudoaneurysms larger than 55 mm in diameter, those needing emergency intervention, and those associated with sepsis carry a poor prognosis. 4,5 The operative management of large ascending aortic pseudoaneurysm remains technically challenging and is associated with high morbidity and mortality rates.…”

Section: Commentmentioning

confidence: 99%

Ascending Aortic Pseudoaneurysm: Sleeping Giant Arises in 3rd Decade after Surgery

Aggarwal¹,

Banga²,

Mungee³

2016

Texas Heart Institute Journal

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“…Despite of axillary artery cannulation being technically more difficult than the aorta or the femoral artery, it promotes antegrade flow through a vessel usually free from atherosclerotic disease [1]. Indications have been broadened, due to its technique being reproducible and safe [2,3]; and it does include installation of cardiopulmonary bypass in patients with extensive atherosclerotic disease [4], aneurysms [5] or aortic dissection [1], intra-aortic balloon pump insertion [6], and circulatory assistance devices [7,8]. It is important to study the issues related to axillar artery cannulation for cardiopulmonary bypass because of the presence of incidental problems that may limit aortic cannulation.…”

Section: Introductionmentioning

confidence: 99%

Artéria axilar na instalação de circulação extracorpórea: indicações e resultados

Atik

Faber²,

Corso³

et al. 2009

Rev Bras Cir Cardiovasc

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Objectives: To determine indications and results of axillary artery cannulation for cardiopulmonary bypass.Methods: From January 2005 through December 2008, axillary artery cannulation was used in 48 patients. Mean age was 62 ±11 years and 33 patients (69%) were males. Axillary artery was approached by infraclavicular incision and the cannula introduced in a 8 millimeter Dacron side graft.Results: Indications were calcified aorta (N=18, 38%), aortic dissection (N=15, 31%), ascending and/or aortic arch aneurysm (N=11, 23%) and prior to reoperative median sternotomy (N=4, 8%). Changes in intraoperative planning occurred most often in patients with calcified aorta (100% versus 10%, P<.0001) than in patients with other indications, which follow their preoperative plan. Cardiopulmonary bypass (deep hypothermic circulatory arrest in 55% and conventional in the remaining) was uneventfully conducted in all patients but one (success rate 98%) due to undiagnosed inominate artery stenosis. Local complication was lymphatic drainage in three patients (6.2%). Bras Cir Cardiovasc 2009; 24(3): 404-408 Conclusions Rev

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Surgical treatment of pseudoaneurysm of the thoracic aorta

Cited by 138 publications

References 24 publications

Ascending Aortic False Aneurysm Formation Associated with Rupture of Acute Type A Aortic Dissection

Ascending Aortic False Aneurysm Formation Associated with Rupture of Acute Type A Aortic Dissection

Ascending Aortic Pseudoaneurysm: Sleeping Giant Arises in 3rd Decade after Surgery

Artéria axilar na instalação de circulação extracorpórea: indicações e resultados

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