TAA 18. Endovascular Treatment of Ascending and Thoracic Aortic Arch Pseudoaneurysm

Abstract

Objective: Thoracic aortic pseudoaneurysms are rare. The main causes of aortic pseudoaneurysms are iatrogenic injury, trauma, atherosclerosis, and infection. Whereas aortic pseudoaneurysm might be asymptomatic, it is potentially fatal and may cause death of 32% to 40% if ruptured. Therefore, treatment should be considered as soon as the diagnosis is made. Treatment options available are surgical, endovascular, and hybrid (surgical and endovascular) methods. However, taking into consideration the etiology of thoracic aorta pseudoaneurysm, the surgical option in patients with multiple combined traumatic injuries, repeated open thoracic surgery, and comorbidities might be associated with higher morbidity and mortality rates. Endovascular treatment of thoracic aortic pseudoaneurysm is a safe, durable, and less invasive alternative. Methods: In this paper, we share our experience in treating thoracic aortic pseudoaneurysm endovascularly. We reviewed cases of thoracic aorta pseudoaneurysm treated endovascularly in our institutions between the years 2017 and 2019. Results: Six patients are included in this study (five male, one female). The mean age was 51 years. The etiology of thoracic aortic pseudoaneurysm was atherosclerosis in two patients, trauma in two patients, and iatrogenic (postsurgical) in two patients. As for the location of the pseudoaneurysms, two were in the ascending aorta (after cardiac surgery). Four were in the aortic arch, of which two were next to the left subclavian artery (post-traumatic). Five patients were treated with thoracic aortic stent grafts. One patient was treated with a multilayer flow modulator stent. In four of these cases, parallel stenting (chimney) was performed to the subclavian and carotid arteries. In these cases, a catheter was placed in the false aneurysm. After deployment of the stent graft, the catheter was used to deliver coils into the false aneurysm. This procedure was devised to expedite thrombosis of the false aneurysm. Some of these aneurysms were gigantic, ranging between 7 and 9 cm in diameter. All procedures were technically successful with excluded pseudoaneurysms. Conclusions: Early outcomes that have been achieved with endovascular repair in this series were satisfactory. Endovascular treatment is safe and effective for thoracic aortic pseudoaneurysm. The choice of treatment should be tailored for patients, taking into consideration the etiology and location of the pseudoaneurysm.