Surgery for pseudoaneurysm of the ascending aorta under moderate hypothermia

Novel modification of a branched arch endograft with a retrograde left common carotid branch for acute pseudoaneurysm post type A repair

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.

Percutaneous repair of a sinotubular junction aortic pseudoaneurysm with an atrial septal defect occluder: a case report

Background

Aortic pseudoaneurysms are complications that arise following cardiac surgery, thoracic trauma, infections, or inflammatory conditions. The mainstay treatment for aortic pseudoaneurysm is surgical management. Given significant morbidity and mortality related to thoracotomy, high-risk patients are not considered for cardiac surgery. Novel percutaneous repair using a variety of devices are being explored, especially in those with prohibitive risk for cardiac surgery.

Case summary

This case describes the use of an Amplatzer atrial septal defect (ASD) occluder device to manage an aortic pseudoaneurysm in a 69-year-old male who had previously undergone coronary artery bypass graft surgery and pericardial drainage for purulent pericarditis. Following successful implant, there were no complications seen after 2 years of follow-up.

Discussion

Percutaneous closure of a mycotic pseudoaneurysm with an Amplatzer ASD occluder device can be a safe and efficacious treatment option, especially in patients with prohibitive surgical risk.

Necessity of life-long follow-up after surgery for coarctation of the aorta: a case series of very late false aneurysm formation

BACKGROUND

Coarctation of the aorta accounts for 5-7% of congenital defects of the heart and great vessels. It requires treatment in the form of open surgical or percutaneous repair. Common long-term complications include re-stenosis and aneurysm formation. The formation of a false aneurysm is a complication with a significant morbidity and mortality.

CASE SUMMARY

We reviewed six cases of late false aneurysm after repair of a coarctation of the aorta. Our six cases developed a false aneurysm after an open surgical repair of a coarctation more than 30 years after initial surgical repair. All aneurysms were located at the aortic repair site.

DISCUSSION

The symptoms or risk factors in the described cases are not uniform and are difficult to include in a general follow-up protocol. Guidelines recommend frequent evaluation, but do not specify duration or intervals of imaging follow-up. Our cases support the necessity of life-long follow-up in patients with open aortic repairs irrespective of symptomatology.

3D model-guided transcatheter closure of ascending aorta pseudoaneurysm with the novel Amplatzer Trevisio intravascular delivery system

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.

Percutaneous endovascular management of ascending aortic pseudoaneurysm after heart transplantation in a pediatric patient

Ascending aortic pseudoaneurysm is a rare complication after HT. Surgery is the most conventional management, but in some patients, it is risky. We report the case of a ten-year-old child who underwent HT and developed an ascending aortic pseudoaneurysm in the aortic anastomosis. He was successfully treated with two covered stents through endovascular management. Endovascular therapy is an alternative management in high-risk patients. To our knowledge, this is the first report about endovascular therapy of an AAP after HT in a pediatric patient.

Surgical Treatment of Pseudoaneurysm of the Ascending Aorta in a Patient with Sepsis

Pseudoaneurysm of the ascending aorta (PAA) is a hazardous and potentially fatal cardiovascular disease. This condition is caused by the rupture of at least one layer of the vessel and contained by the remaining vascular layers or the surrounding mediastinal structures. We presented the surgical treatment of a patient with sepsis and large PAA and brachiocephalic trunk, which was compressing the brachiocephalic trunk leading to syncope.

Get out of trouble during redo surgery for false aneurysm of the ascending aorta

Postoperative thoracic aortic false aneurysm is a challenging complication of aortic surgery. We describe our surgical approach for an 8-cm thoracic aorta false aneurysm in a 59-year-old woman who had previously undergone aortic surgery. Surgery must be planned carefully because massive hemorrhage during resternotomy is a dreadful complication of postoperative false aneurysm surgery. We decided to start cardiopulmonary bypass before resternotomy and use a ventricular vent from the apex, an endo-vent from the pulmonary artery, and an endo-balloon with antegrade blood cardioplegia. We successfully performed the procedure without profound hypothermia and circulatory arrest and with a low risk of hemorrhage.

Interventional Closure of a Large Pseudoaneurysm of the Ascending Aorta in a Patient after Lung Transplantation

•

Pseudoaneurysm is a rare but life-threatening complication after thoracic surgery.

•

Standard therapy is surgical occlusion and excision of the aneurysm.

•

Interventional closure with ASD occluder is an alternative for patients deemed inoperable.

Imaging of vascular pseudoaneurysms in the thorax and abdomen

INTRODUCTION

This review article illustrates a spectrum of arterial pseudoaneurysms that may occur in various locations throughout the thoracoabdominal region. This article discusses the common etiologies and typical clinical presentations of arterial pseudoaneurysms as well as the imaging modalities employed in their diagnosis and potential treatment options.

OBJECTIVE

The goal of this review article is to familiarize radiologists with the diagnosis of thoracoabdominal arterial pseudoaneurysms, the prompt identification and treatment of which are crucial in this patient population.

CONCLUSION

In summary, a thorough understanding of the etiologies, imaging characteristics, and clinical implications of pseudoaneurysms can help optimize identification and management of this spectrum of disease.

A rare complication: aorta-cutaneous fistula with abundant bleeding

Pseudoaneurysm and aorto-cutaneous fistula following surgical procedures of the aorta are rare complications with potentially catastrophic results that require rapid diagnosis and urgent surgical treatment. We performed a successful life-saving operation using hypothermic circulatory arrest with femoral artery and vein cannulation. The patient had undergone open heart surgery in our clinic twice, and there was active and abundant bleeding from aorta-cutaneous fistula that occured 5 years after the last surgery.