1
|
Ferraresi M, Katsarou M, Luigi Molinari AC, Segreti S, Rossi G. Endovascular repair of ascending aortic pathologies in patients unfit for open surgery: case series and literature review. J Vasc Surg Cases Innov Tech 2024; 10:101455. [PMID: 38510094 PMCID: PMC10951535 DOI: 10.1016/j.jvscit.2024.101455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/26/2024] [Indexed: 03/22/2024] Open
Abstract
The number of vascular centers performing endovascular repair of ascending aortic disease is constantly increasing. Accordingly to the guidelines, open surgical repair remains the gold standard for these pathologies. However, approximately one quarter of patients are deemed unfit for open surgery. In this study, we describe three cases of ascending thoracic endovascular aortic repair (TEVAR) performed at our center. All the patients were deemed unfit for open surgery by the aortic team. Two patients had an ascending aortic pseudoaneurysm, and the third had a focal type A aortic dissection. In two cases, we used two abdominal aortic cuffs deployed from zone 0B to zone 0C, with no need for supra-aortic trunk debranching. In one case, we performed a "reverse" extrathoracic debranching, and we deployed a thoracic endograft from zone 0B to zone 2. Complications included one minor stroke and one inguinal hematoma. In one patient with an infected pseudoaneurysm, we performed ascending TEVAR as a bridge strategy for open repair. This patient developed a type Ia endoleak; however, clinical stabilization and infection control were obtained, and he was able to undergo heart surgery successfully. He underwent a second reintervention to treat superior mesenteric embolic occlusion. At 2 years of follow-up, all three patients were alive. Our preliminary experience demonstrates the technical feasibility and clinical appropriateness of ascending TEVAR using standard, commercially available endografts. However, no consensus has been reached regarding some critical aspects, such as the development of a standardized technique or the efficacy of the currently available devices. The improvements in graft design and the adoption of the "aortic team" approach could help in the near future to standardize the procedure, establish appropriate indications, and ensure good clinical outcomes.
Collapse
Affiliation(s)
- Marco Ferraresi
- Division of Vascular Surgery, Cardio-Thoracic-Vascular Department, Alessandro Manzoni Hospital, Lecco, Italy
| | - Maria Katsarou
- Division of Vascular Surgery, Cardio-Thoracic-Vascular Department, Alessandro Manzoni Hospital, Lecco, Italy
| | | | - Sara Segreti
- Division of Vascular Surgery, Cardio-Thoracic-Vascular Department, Alessandro Manzoni Hospital, Lecco, Italy
| | - Giovanni Rossi
- Division of Vascular Surgery, Cardio-Thoracic-Vascular Department, Alessandro Manzoni Hospital, Lecco, Italy
| |
Collapse
|
2
|
Ascending aorta thoracic endovascular aortic repair for infected pseudoaneurysm. J Vasc Surg Cases Innov Tech 2022; 8:244-247. [PMID: 35510219 PMCID: PMC9058959 DOI: 10.1016/j.jvscit.2022.02.005] [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] [Received: 08/06/2021] [Accepted: 02/12/2022] [Indexed: 12/02/2022] Open
Abstract
A 70-year-old woman with a bioprosthetic aortic valve replacement for aortic valve endocarditis complicated by recurrent endocarditis and requiring homograft aortic root replacement 10 years earlier had presented at 1 month after her admission for pseudomonal bacteremia with right-sided chest pain. An aortic pseudoaneurysm, identified on computed tomography, was treated with an ascending aorta thoracic endovascular aortic repair using two overlapping abdominal aortic stent grafts in the ascending aorta. Postoperative and follow-up imaging demonstrated exclusion of the pseudoaneurysm with stable positioning of the stent grafts. Ascending aorta thoracic endovascular aortic repair can be performed safely with good short-term results in patients presenting with infected pseudoaneurysms of the ascending aorta.
Collapse
|
3
|
Hauck SR, Kupferthaler A, Stelzmüller M, Eilenberg W, Ehrlich M, Neumayer C, Wolf F, Loewe C, Funovics MA. Endovascular Stent-Graft Repair of the Ascending Aorta: Assessment of a Specific Novel Stent-Graft Design in Phantom, Cadaveric, and Clinical Application. Cardiovasc Intervent Radiol 2021; 44:1448-1455. [PMID: 34180002 PMCID: PMC8382630 DOI: 10.1007/s00270-021-02859-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/24/2021] [Indexed: 11/24/2022]
Abstract
Purpose To test a stent-graft specifically designed for the ascending aorta in phantom, cadaver, and clinical application, and to measure deployment accuracy to overcome limitations of existing devices. Methods A stent-graft has been designed with support wires to fixate the apices toward the inner curvature, thereby eliminating the forward movement of the proximal end which can happen with circumferential tip capture systems. The device was deployed in three aortic phantoms, and in four cadavers, deployment precision was measured. Subsequently, the device was implanted in a patient to exclude a pseudoaneurysm originating from the distal anastomosis after ascending aortic replacement. Results The stent-grafts were successfully deployed in all phantoms and cadavers. Deployment accuracy of the proximal end of the stent-graft was within 1 mm proximally and 14 mm distally to the intended landing zone on the inner curvature, and 2–8 mm distal to the intended landing zone on the outer curvature. In clinical application, the pseudoaneurysm could be successfully excluded without complications. Conclusion The novel stent-graft design promises accurate placement in the ascending aorta. The differential deployment of the apices at the inner and outer curvatures allows deployment perpendicular to the aortic axis. Level of Evidence No level of evidence.
Collapse
Affiliation(s)
- Sven R Hauck
- Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Alexander Kupferthaler
- Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.,Department of Diagnostic and Interventional Radiology, Ordensklinikum Linz, Linz, Austria
| | - Marlies Stelzmüller
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Wolf Eilenberg
- Department of Vascular Surgery, Medical University of Vienna, Vienna, Austria
| | - Marek Ehrlich
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Neumayer
- Department of Vascular Surgery, Medical University of Vienna, Vienna, Austria
| | - Florian Wolf
- Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Martin A Funovics
- Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
4
|
A systematic review of primary endovascular repair of the ascending aorta. J Vasc Surg 2018; 67:332-342. [DOI: 10.1016/j.jvs.2017.06.099] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 06/19/2017] [Indexed: 11/21/2022]
|
5
|
Affiliation(s)
- George Joseph
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Lars Lönn
- Department of Cardiovascular Radiology, Faculty of Health Sciences, The National Hospital and University of Copenhagen, Denmark
| |
Collapse
|
6
|
|
7
|
Affiliation(s)
- George Joseph
- 1 Department of Cardiology, Christian Medical College, Vellore, India
| | - Ludovic Canaud
- 2 Service de Chirurgie Vasculaire et Thoracique, Hôpital A de Villeneuve, Montpellier, France
| |
Collapse
|
8
|
Khoynezhad A, Donayre CE, Walot I, Koopmann MC, Kopchok GE, White RA. Feasibility of endovascular repair of ascending aortic pathologies as part of an FDA-approved physician-sponsored investigational device exemption. J Vasc Surg 2016; 63:1483-95. [DOI: 10.1016/j.jvs.2015.12.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/21/2015] [Indexed: 11/25/2022]
|
9
|
Piffaretti G, Galli M, Lomazzi C, Franchin M, Castelli P, Mariscalco G, Trimarchi S. Endograft repair for pseudoaneurysms and penetrating ulcers of the ascending aorta. J Thorac Cardiovasc Surg 2016; 151:1606-14. [DOI: 10.1016/j.jtcvs.2015.12.055] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/18/2015] [Accepted: 12/24/2015] [Indexed: 11/30/2022]
|
10
|
Salsamendi J, Pereira K, Rey J, Narayanan G. Endovascular Coil Embolization in the Treatment of a Rare Case of Post-Traumatic Abdominal Aortic Pseudoaneurysms: Brief Report and Review of Literature. Ann Vasc Surg 2016; 30:310.e1-8. [DOI: 10.1016/j.avsg.2015.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 07/11/2015] [Accepted: 07/19/2015] [Indexed: 11/25/2022]
|
11
|
Wang W, Liu X, Lu M. Case-report: endovascular treatment of aortic pseudo-aneurysm caused by Fishbone. J Cardiothorac Surg 2015; 10:94. [PMID: 26152238 PMCID: PMC4494703 DOI: 10.1186/s13019-015-0304-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 06/29/2015] [Indexed: 01/08/2023] Open
Abstract
Aortic pseudo-aneurysm (APA) is a rare disease in clinic. Because of its relative rarity, we are far from making any conclusion regarding the natural history and appropriate therapeutic strategy for this condition. This study is to investigate the treatment effect of interventional therapy in aortic pseudo-aneurysm. A woman of 68 years old diagnosed with APA caused by fishbone was treated with stent grafts. After treatment, the therapeutic effect was assessed by measuring the size of trauma. The patient recovered well after stent grafts treatment, as her trauma was minimal. However, some complications of intravascular interventional treatment were observed. Compared with conventional surgery, interventional therapy of intravascular stent grafts has its merits. Therefore, this strategy was worthy to apply in the treatment of aortic pseudo-aneurysm.
Collapse
Affiliation(s)
- Wei Wang
- Department of Cardiology, the First Affiliated Hospital of Guangzhou Medical University, No.151 Yanjiang West Road, Guangzhou, 510120, China.
| | - Xuesong Liu
- Department of Cardiology, the First Affiliated Hospital of Guangzhou Medical University, No.151 Yanjiang West Road, Guangzhou, 510120, China.
| | - Mingjun Lu
- Department of Cardiology, the First Affiliated Hospital of Guangzhou Medical University, No.151 Yanjiang West Road, Guangzhou, 510120, China.
| |
Collapse
|
12
|
El-Sayed Ahmad A, Papadopoulos N, Detho F, Srndic E, Risteski P, Moritz A, Zierer A. Surgical Repair for Acute Type A Aortic Dissection in Octogenarians. Ann Thorac Surg 2015; 99:547-51. [DOI: 10.1016/j.athoracsur.2014.08.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/28/2014] [Accepted: 08/06/2014] [Indexed: 11/28/2022]
|
13
|
Asymptomatic Mycotic Aneurysm of Ascending Aorta After Heart Transplantation: A Case Report. Transplant Proc 2015; 47:213-6. [DOI: 10.1016/j.transproceed.2014.10.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 10/28/2014] [Indexed: 01/19/2023]
|
14
|
Shaikhrezai K, Nanjaiah P, Ingram SM, Brackenbury ET. Staged hybrid treatment of ascending aorta aneurysm post cardiac surgery. Interact Cardiovasc Thorac Surg 2013; 16:917-9. [PMID: 23475117 DOI: 10.1093/icvts/ivt094] [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: 11/12/2022] Open
Abstract
We describe the management of ascending aorta aneurysm following a recurrent sternotomy wound infection in 2 male patients. The patients had undergone cardiac surgery using cardiopulmonary bypass with late complications of chronic sternal wound infection and saccular aneurysm at the aortic cannulation site. In both patients, following a multidisciplinary approach, a customized stent graft was implanted endovascularly into the ascending aorta to seal the aneurysm orifice followed by resternotomy, repair of the aneurysm and omentopexy. Both patients' postoperative course was uneventful.
Collapse
Affiliation(s)
- Kasra Shaikhrezai
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | | |
Collapse
|
15
|
Joyce DL, Singh SK, Mallidi HR, Dake MD. Endovascular Management of Pseudoaneurysm Formation in the Ascending Aorta Following Lung Transplantation. J Endovasc Ther 2012; 19:52-7. [DOI: 10.1583/11-3601.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
16
|
Gelpi G, Cagnoni G, Vanelli P, Antona C. Endovascular repair of ascending aortic pseudoaneurysm in a high-risk patient. Interact Cardiovasc Thorac Surg 2011; 14:494-6. [PMID: 22199178 DOI: 10.1093/icvts/ivr134] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Mycotic ascending aortic pseudoaneurysm (AAP) is an uncommon but surgically challenging problem with high morbidity and mortality rates. We describe endovascular repair of an acute mycotic AAP in a high-risk patient. A 45-year old man, HIV serum positive, chronic hepatitis HBV and HCV related, presented, after two sternotomies, with a fast growing 11 6 cm AAP that was sealed with two Gore Exluder aortic cuffs, inserted from the left axillary artery. Nine months control CT continued to show no endoleak with shrinking of the AAP.
Collapse
Affiliation(s)
- Guido Gelpi
- Cardiovascular Surgery Division of L. Sacco Hospital, University of Milan, Milan, Italy.
| | | | | | | |
Collapse
|
17
|
Endovascular management of ascending aortic pathology. J Vasc Surg 2011; 53:1431-7. [DOI: 10.1016/j.jvs.2010.10.133] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 10/13/2010] [Accepted: 10/24/2010] [Indexed: 11/18/2022]
|
18
|
Vaughan-Huxley E, Hamady M, Metcalfe M, Adams B, Kashef E, Cheshire N, Bicknell C. Endovascular Repair of an Acute, Mycotic, Ascending Aortic Pseudoaneurysm. Eur J Vasc Endovasc Surg 2011; 41:488-91. [DOI: 10.1016/j.ejvs.2010.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 12/13/2010] [Indexed: 11/15/2022]
|
19
|
Zago AC, Saadi EK, Zago AJ. Endovascular approach to treat ascending aortic pseudoaneurysm in a patient with previous CABG and very high surgical risk. Catheter Cardiovasc Interv 2011; 78:551-7. [DOI: 10.1002/ccd.23005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 01/20/2011] [Indexed: 11/08/2022]
|
20
|
Veroux P, D'Arrigo G, Giaquinta A, Virgilio C, Cappellani A, Veroux M. Emergency Endovascular Repair of Two Ascending Aortic Pseudoaneurysms. J Vasc Interv Radiol 2011; 22:417-9. [DOI: 10.1016/j.jvir.2010.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 10/19/2010] [Accepted: 11/06/2010] [Indexed: 11/25/2022] Open
|
21
|
Uchida K, Imoto K, Yanagi H, Machida D, Okiyama M, Yasuda S, Sugiura T, Kawaguchi S, Yokoi Y, Shigematsu H, Masuda M. Endovascular Repair of Ascending Aortic Rupture: Effectiveness of a Fenestrated Stent-Graft. J Endovasc Ther 2010; 17:395-8. [DOI: 10.1583/10-3033.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
22
|
Sirin G, Yilmaz O, Demirsoy E, Alan S, Soybir N, Sönmez B. Mycotic ascending aortic pseudoaneurysm at aortic cannulation site. Asian Cardiovasc Thorac Ann 2009; 17:417-8. [PMID: 19713342 DOI: 10.1177/0218492309338095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mycotic aneurysm of the aorta is a rare but highly fatal complication of coronary bypass surgery. A 49-year-old man developed mycotic pseudoaneurysm in the ascending aorta after coronary bypass in another hospital. Computed tomography showed the pseudoaneurysm originated from the previous aortic cannulation site. The defect was successfully repaired with pericardial-pledgeted sutures.
Collapse
Affiliation(s)
- Gökçe Sirin
- Department of Cardiovascular Surgery, Istanbul Memorial Hospital, Sişli, Istanbul, Turkey.
| | | | | | | | | | | |
Collapse
|
23
|
Geiger-Gritsch S, Piso B, Guba B, Felder-Puig R. [Endovascular deployment of stent graft in the ascending aorta. A systematic review]. Chirurg 2009; 80:634-40. [PMID: 19225740 DOI: 10.1007/s00104-009-1672-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The endovascular deployment of stent graft in the ascending aorta was proposed for inclusion in the benefit catalogue of the Austrian Federal Ministry of Health. The efficacy and safety of this intervention was unclear, and therefore a systematic review was performed to support evidence-based decision making. Detailed searches for English- or German-language articles published between 2002 and 2008 were performed in a number of electronic databases. Internal validity of studies was judged by two authors independently. A total of 11 case reports but no prospective studies were identified through literature search. The case reports showed the technical feasibility of this intervention but allow no conclusions about its efficacy and safety. Therefore the endovascular deployment of stent graft in the ascending aorta must be considered as experimental and its inclusion in the benefit catalogue cannot be recommended.
Collapse
Affiliation(s)
- S Geiger-Gritsch
- Ludwig Boltzmann Institut für Health Technology Assessment, Garnisongasse 7/20, Vienna, Austria.
| | | | | | | |
Collapse
|
24
|
Interventional radiology in the diagnosis, management, and follow-up of pseudoaneurysms. Cardiovasc Intervent Radiol 2008; 32:2-18. [PMID: 18923864 DOI: 10.1007/s00270-008-9440-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 08/15/2008] [Accepted: 09/03/2008] [Indexed: 02/05/2023]
Abstract
Arterial wall disruption, as a consequence of inflammation/infection, trauma (penetrating or blunt), or iatrogenic causes, may result in pseudoaneurysm formation. Currently, iatrogenic causes are increasing as a result of the growth of endovascular intervention. The frequency of other causes also seems to be increasing, but this may simply be the result of increased diagnosis by better imaging techniques, such as multidetector contrast-enhanced computed tomography. Clinically, pseudoaneurysms may be silent, may present with local or systemic signs, or can rupture with catastrophic consequences. Open surgical repair, previously the mainstay of treatment, has largely been replaced by image-guided occlusion methods. On the basis of an experience of over 100 pseudoaneurysms, treatments at various anatomical sites, imaging modalities used for accurate diagnosis, current changing therapeutic options for pseudoaneurysm management, approved embolization agents, and clinical follow-up requirements to ensure adequate treatment will be discussed. Image-guided direct percutaneous and endovascular embolization of pseudoaneurysms are established treatment options with favorable success rates and minimal morbidity. The pendulum has now swung from invasive surgical repair of pseudoaneurysms to that of image-guided interventional radiology.
Collapse
|
25
|
Hussain Q, Maleux G, Heye S, Fourneau I. Endovascular repair of an actively hemorrhaging stab wound injury to the abdominal aorta. Cardiovasc Intervent Radiol 2008; 31:1023-5. [PMID: 18389184 DOI: 10.1007/s00270-008-9327-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Revised: 02/13/2008] [Accepted: 03/03/2008] [Indexed: 11/27/2022]
Abstract
Traumatic injury of the abdominal aorta is rare and potentially lethal (Yeh et al., J Vasc Surg 42(5):1007-1009, 2005; Chicos et al., Chirurgia (Bucur) 102(2):237-240, 2007) as it can result in major retroperitoneal hemorrhage, requiring an urgent open surgery. In case of concomitant bowel injury or other conditions of hostile abdomen, endovascular repair can be an alternative treatment. This case report deals with a 50-year-old man presenting at the emergency ward with three stab wounds: two in the abdomen and one in the chest. During explorative laparotomy, liver laceration and bowel perforation were repaired. One day later, abdominal CT-scan revealed an additional retroperitoneal hematoma associated with an aortic pseudoaneurysm, located anteriorly 3 cm above the aortic bifurcation. Because of the risk of graft infection, an endovascular repair of the aortic injury using a Gore excluder stent-graft was performed. Radiological and clinical follow-up revealed a gradual shrinkage of the pseudo-aneurysm and no sign of graft infection at two years' follow-up.
Collapse
Affiliation(s)
- Qasim Hussain
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | | | | |
Collapse
|