Device occlusion of pseudoaneurysm of ascending aorta

Abstract

Pseudoaneurysm of ascending aorta is an infrequent but well-recognized and potentially fatal complication after cardiac surgeries. The complication can develop early, delayed or late, and the presentation is also varied. We are presenting here two cases of pseudoaneurysm of ascending aorta following cardiac surgery that were successfully managed by the transcatheter method. The first one occurred following coronary artery bypass surgery and the second one occurred following double-valve replacement surgery. The aortic openings of these aneurysms were occluded with 12 mm and 10 mm atrial septal occluders, respectively, with a good outcome. An immediate postprocedure angiogram showed no residual flow into the sac. Six months of follow-up of both cases also showed excellent results.

An uncommon percutaneous treatment of aortic pseudoaneurysm

“…Aortic pseudoaneurysms are observed with a variety of aortic diseases with disruption of arterial wall layers and they are rare complications of post cardiothoracic surgeries because of weakness of the aortic wall, typically at the sites of graft anastomosis; needle/cannulation of the ascending aorta; or cross-clamping ( 1 , 5 ). Clinical presentation can change from asymptomatic to catastrophic rupture ( 2 ). Even though conventional treatment of the pseudoaneurysm is surgical ligation or replacement with a graft, surgical procedures have higher morbidity and mortality rates ( 3 ).…”

“…It does not include all layers of the artery. Clinical presentation can vary from asymptomatic to catastrophic outcomes ( 2 ). Although surgical management is the commonly accepted treatment, it can be related with high morbidity and mortality ( 3 ); therefore, endovascular strategies, such as thrombin injection, coiling, endovascular stenting, and Amplatzer occluder devices, are emerging as alternative treatment modalities which have fewer complication rates ( 4 ).…”

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

“…The first case of percutaneous APA closure with an Amplatzer septal occluder was reported by Bashir et al in 2005 . Over the ensuing decade there have been numerous reports describing this method of treatment, largely in patients who have had multiple comorbidities unsuitable for surgery . We have summarized 22 publications covering 34 cases in Table .…”

“…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.…”

“…APAs occur at areas of weaknesses in the aortic wall, typically at the sites of graft anastomosis, needle/cannulation of the ascending aorta or cross‐clamping . Clinical presentation is often varied, and ranges from the entirely asymptomatic patient to compressive symptoms, mediastinitis, or catastrophic rupture . Reoperation on the thoracic aorta for APA is however not without risk, with a reported hospital mortality of 6.9% .…”