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Lim ET, Benson R, Lyons O, Laing A, Khanafer A. Novel modification of a branched arch endograft with a retrograde left common carotid branch for acute pseudoaneurysm post type A repair. Vascular 2024; 32:533-536. [PMID: 36647802 DOI: 10.1177/17085381231153219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Pseudoaneurysm formation post type A aortic dissection repair is rare. Revision surgical repair is challenging, with a risk of death from haemorrhage. METHODS We present a 56-year-old man who presented with a rapidly enlarging distal ascending aortic anastomotic pseudoaneurysm following a recent ascending and hemiarch replacement for acute type A aortic dissection. RESULTS A tight kink in the ascending aortic graft precluded an endovascular repair utilizing two antegrade branches, and so a novel custom-made 3 inner branched aortic endograft was designed, with an antegrade brachiocephalic inner branch and retrograde left common carotid and subclavian artery inner branches. The patient required an angioplasty to dilate the kinked/coarcted surgical graft, but made an uneventful recovery. CONCLUSION An aortic arch inner branch design with an antegrade brachiocephalic branch but retrograde left common carotid and left subclavian branches was feasible and may prove particularly useful when there is limited space in the ascending aorta.
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Affiliation(s)
- Eric Ta Lim
- Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, Christchurch, New Zealand
- Department of Surgery, University of Otago Christchurch, Christchurch, New Zealand
| | - Ruth Benson
- Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, Christchurch, New Zealand
- Department of Surgery, University of Otago Christchurch, Christchurch, New Zealand
| | - Oliver Lyons
- Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, Christchurch, New Zealand
- Department of Surgery, University of Otago Christchurch, Christchurch, New Zealand
| | - Andrew Laing
- Department of Interventional Radiology, Christchurch Hospital, Christchurch, New Zealand
| | - Adib Khanafer
- Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, Christchurch, New Zealand
- Department of Surgery, University of Otago Christchurch, Christchurch, New Zealand
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Recicarova S, Jonak M, Netuka I. Comprehensive multi-modality treatment of thoracic aorta pseudoaneurysms: a single-center experience. Gen Thorac Cardiovasc Surg 2024; 72:387-394. [PMID: 38001300 PMCID: PMC11127891 DOI: 10.1007/s11748-023-01986-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Thoracic aorta false aneurysms (TAFA) are unexplored complications after cardiac surgery associated with significant morbidity and mortality. Therefore, the purpose of this study was to examine the clinical profiles, surgical techniques, and operative outcomes, of patients treated for TAFA at a single institution. METHODS From 1996 to 2022, 112 patients were treated for aortic pseudoaneurysm (mean age 55 ± 14 years, 78 patients were male). In the majority of the patients (90%) TAFA developed after previous cardiovascular surgery, the most common diagnosis and surgical procedure preceding the TAFA development was an aortic dissection (52%) and Bentall procedure (47%). In the rest of the cohort, the leading cause was trauma. RESULTS Sixty-one percent of patients were indicated for reintervention (surgical reoperation, endoluminal graft implantation, septal occluder implantation, coil embolization, or a combination of procedures). Overall, 52 patients had undergone cardiac reoperation. TAFA was resected and the aorta was repaired in 55% or replaced in 45%. Operative mortality was 5.7%. In postoperative follow-up, a hypoechogenic lesion encircling aortic prosthesis was present in 94%, therefore it was determined as a negative prognostic factor. The mean follow-up was 13.2 ± 19.4 years. CONCLUSION Although there is no specific approach how to prevent TAFA development, maintaining normal blood pressure and regular follow-up should be applied. More frequent follow-ups should be performed in patients with a hypoechogenic lesion encircling and aortic prosthesis. Early detection during long-term postoperative follow-up, an individually tailored approach of a multidisciplinary team is necessary for favorable treatment outcomes.
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Affiliation(s)
- Sandra Recicarova
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine (IKEM), Videnska 1958/9, Prague, 140 00, Czech Republic.
- First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Michael Jonak
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine (IKEM), Videnska 1958/9, Prague, 140 00, Czech Republic
| | - Ivan Netuka
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine (IKEM), Videnska 1958/9, Prague, 140 00, Czech Republic
- Second Department of Surgery, Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Nakhaee A, Parkhideh R, Rahmanian M, Pouraliakbar H, Sardari A, Larti F, Badkoubeh RS. Re-emphasis on the role of echocardiography in diagnosis of aortic root surgery complications. Echocardiography 2022; 39:1344-1347. [PMID: 36198100 DOI: 10.1111/echo.15430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/01/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Aortic pseudoaneurysm is an infrequent complication of ascending aorta surgery. CASES This is a report of two cases that underwent the Bentall procedure that presented with large pseudoaneurysms. CONCLUSION Use of multimodality imaging after Bentall surgery has been advocated for the detection of surgical complications. Although 3D CT angiography has the highest diagnostic accuracy, familiarity with transthoracic echocardiographic finding in these patients will lead to earlier diagnosis.
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Affiliation(s)
- Akram Nakhaee
- Department of Echocardiography, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Parkhideh
- Department of Echocardiography, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrzad Rahmanian
- Department of Cardiovascular Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pouraliakbar
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Akram Sardari
- Department of Echocardiography, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnoosh Larti
- Department of Echocardiography, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Sattarzadeh Badkoubeh
- Department of Echocardiography, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Santoro G, Rizza A, Pizzuto A, Berti S, Cuman M, Gasparotti E, Capellini K, Cantinotti M, Clemente A, Celi S. Transcatheter Treatment of Ascending Aorta Pseudoaneurysm Guided by 3D-Model Technology. JACC Case Rep 2022; 4:343-347. [PMID: 35495557 PMCID: PMC9040102 DOI: 10.1016/j.jaccas.2022.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/08/2021] [Accepted: 01/03/2022] [Indexed: 11/26/2022]
Abstract
Ascending aorta pseudoaneurysm is a rare but potentially life-threatening complication of atherosclerosis, infections, chest trauma, transcatheter or surgical interventions. Due to high surgical risk, percutaneous closure is considered a valuable cost-effective therapeutic alternative. In this setting, 3D printing technology is emerging as a powerful tool to plan transcatheter repair. (Level of Difficulty: Advanced.)
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Lyonga Ngonge A, Ganta N, Jalal Eldin A, Effoe V, Nso N, Williams D. The Dilemma in the Management of Thromboembolic Disease in the Setting of Concomitant Aortic Pseudoaneurysm. Cureus 2021; 13:e20668. [PMID: 35106211 PMCID: PMC8786573 DOI: 10.7759/cureus.20668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2021] [Indexed: 11/29/2022] Open
Abstract
Ascending aortic pseudoaneurysm (AAP) is a rare and serious complication of cardiothoracic surgeries or blunt chest trauma. We present a patient with paroxysmal atrial fibrillation, acute right pontine stroke, and acute pulmonary embolism (PE) with an incidental AAP that precluded the use of anticoagulation and surgery. The case findings substantiate the need for a CT-based assessment of aortic pathology after coronary artery bypass grafting (CABG) in the asymptomatic patient to determine the most appropriate treatment modalities. However, the high cost of CT imaging and the potential radiation exposure challenge its routine use in high-risk patients.
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Cuman M, Clemente A, Celi S, Santoro G. 3D model-guided transcatheter closure of ascending aorta pseudoaneurysm with the novel Amplatzer Trevisio intravascular delivery system. Catheter Cardiovasc Interv 2021; 99:140-144. [PMID: 34463417 DOI: 10.1002/ccd.29937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/07/2021] [Accepted: 08/21/2021] [Indexed: 11/12/2022]
Abstract
Ascending aorta pseudoaneurysm (AAP) is a rare but life-threatening complication of atherosclerosis, endocarditis, chest trauma, transcatheter or cardio-thoracic procedures. Since surgical repair is burdened by high morbidity and mortality, percutaneous closure is nowadays considered a valuable cost-effective therapeutic alternative. Due to unpredictability and complexity of local anatomy, no standardized technique and device are advised. In this setting, 3D printing technology could significantly help in planning trans-catheter approach. This article reports on a 3D printed model-guided percutaneous closure of a huge AAP using an Amplatzer Septal Occluder (Abbott, Plymouth MN) implanted by the recently commercialized Amplatzer Trevisio Intravascular Delivery System.
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Affiliation(s)
- Magdalena Cuman
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Alberto Clemente
- Radiodiagnostic Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Simona Celi
- Bioengineering Section, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Giuseppe Santoro
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
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Double pseudoaneurysms of the aortic bulbus after aortic valve replacement surgery. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 16:141-143. [PMID: 31708990 PMCID: PMC6836632 DOI: 10.5114/kitp.2019.88606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/24/2019] [Indexed: 11/28/2022]
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Kim MG, Kang WC, Oh PC, Jeon YB, Lee JY, Shin EK. Protective effect of angulated aorta for saving coronary artery during endovascular repair for ascending aortic pseudoaneurysm. J Thorac Dis 2016; 8:E667-71. [PMID: 27621896 DOI: 10.21037/jtd.2016.05.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ascending aortic pseudoaneurysm is a rare complication after cardiothoracic surgery and the open surgical repair for this complication is challenging. We report on a patient who developed an ascending aortic pseudoaneurysm after aortic valve replacement (AVR), which was treated successfully with endovascular therapy. Our case showed that angulation of the ascending aorta is one of factors for consideration in application of endovascular therapy and endovascular therapy might be an option for management of ascending aortic pathology in patients with high surgical risk, particularly patients with a severely angulated proximal ascending aorta.
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Affiliation(s)
- Myeong Gun Kim
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Woong Chol Kang
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Pyung Chun Oh
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yang Bin Jeon
- Department of Cardiovascular Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Ji Yeon Lee
- Department of Anesthesiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Eak Kyun Shin
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
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He S, Chen X, Zhou X, Hu Q, Ananda S, Zhu S. Sudden death due to traumatic ascending aortic pseudoaneurysms ruptured into the esophagus: 2 case reports. Medicine (Baltimore) 2015; 94:e716. [PMID: 25881850 PMCID: PMC4602502 DOI: 10.1097/md.0000000000000716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We present 2 rare cases of patients with uncontrolled hemorrhagic shock induced by traumatic ascending aortic pseudoaneurysm rupture into the esophagus. Two men were presented to the hospital after traffic accidents. Their chest radiograph showed no obvious signs of aortic damage or aortic pseudoaneurysms but only a small amount of high-density shadow in the mediastinum and no specific clinical signs besides chest tightness or chest tenderness. The first case was misdiagnosed as pulmonary contusion and pleural effusion, and the second case was misdiagnosed as mediastinal lesions in the mediastina. They were given symptomatic and supportive treatment. Unfortunately, they died suddenly after >1 month of traumatic accident. At autopsy, ascending aortic pseudoaneurysms that broke into the esophagus and multiple organ hematocele were detected by gross examination. In histopathological examination, inflammatory cells and proliferated fibrous connective tissue were detected in the ascending aortic pseudoaneurysms, and the pathological gastrointestinal bleeding was not seen. The drugs and poisons were not found on toxicological analysis. The 2 patients died as a result of hemorrhagic shock from traumatic ascending aortic pseudoaneurysm rupture into the esophagus. We suggest that thoracic surgeon should be aware of the possibility of aortic injury after chest trauma to reduce misdiagnosis and prevent similar accidents.
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Affiliation(s)
- Shixia He
- From the Department of Forensic Medicine (SH, XC, XZ, QH, SZ), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; and Ministry of Health and Quality of Life (SA), Mauritius
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Zicho D, Cartwright N, Bizzarri F, Malkin C, Cross M, Mcpherson S, Kaul P, Puppala S. Endovascular Stent Graft Repair of Suture-Line Pseudoaneurysm Following Ascending Aorta Replacement. Vasc Endovascular Surg 2013; 48:251-5. [DOI: 10.1177/1538574413513847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ascending aorta pseudoaneurysm (AAPA) is an uncommon complication following replacement of the ascending aorta with a prosthetic graft, carry a high risk of rupture, and warrant urgent intervention. The open surgical procedure “gold standard” of care is not always favorable, as the reoperations are technically more difficult or patient’s general condition doesn’t allow proceeding. Case discussed is an 80-year-old male patient who presented with worsening cough and hemoptysis. He underwent ascending aorta replacement 10 years ago. Computed tomography (CT) scan revealed a contrast-filled mediastinal mass communicating with the ascending aorta and extended into the right lung. Due to the patient’s advanced age, friability and clinical condition, combined with the position of the AAPA behind the sternum, surgery was deemed to be high risk. However, favorable anatomical conditions provided a safe landing zone for an endovascular stent. The patient underwent closed procedure. Postprocedure CT showed complete obliteration of the AAPA.
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Affiliation(s)
- David Zicho
- Leeds Teaching Hospital, Leeds, United Kingdom
| | | | | | | | | | | | - Pankaj Kaul
- Leeds Teaching Hospital, Leeds, United Kingdom
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