Hybrid Thoracic Endovascular Aortic Repair for Intercostal Patch Aneurysm after Thoracoabdominal Aortic Replacement

Endovascular Treatment of a Ruptured Pseudoaneurysm of the Intercostal Patch after Descending Aortic Aneurysm Repair

Anastomotic pseudoaneurysm and patch aneurysm are life-threatening complications following thoracoabdominal and descending thoracic aortic aneurysm (DTAA) repair. The aortic wall tissue is fragile in patients with Marfan syndrome, who are at high risk of anastomotic pseudoaneurysm and patch aneurysms. We experienced a rare case of ruptured pseudoaneurysm of the intercostal patch after DTAA repair in a patient with Marfan syndrome. A hematoma was separated from the pseudoaneurysm caused by adhesion of the left lung after DTAA repair, which made diagnosis difficult. To prevent type II endoleak and achieve thoracic endovascular aortic repair, we treated the patent intercostal arteries by embolization.

Thoracic Endovascular Aortic Repair for Ruptured Intercostal Patch Aneurysm Following Thoracoabdominal Aortic Aneurysm Repair

Aneurysmal change of reconstructed intercostal arteries is believed to be a rare complication after thoracoabdominal aortic repair. To our knowledge, there is no guideline or randomized controlled trials regarding intercostal patch aneurysm management. Therefore, the optimal treatment is still controversial. We describe a successful case of emergent thoracic endovascular aortic repair for ruptured intercostal patch aneurysm in an 83-year-old man following thoracoabdominal aortic aneurysm repair. Our experience illustrated that gradual expansion of large blocks of aortic wall reconstruction should be closely monitored after primary thoracoabdominal aortic replacement.

Suture Line Dehiscence after Endovascular Aneurysm Repair in a Patient with Marfan Syndrome

A 68-year-old man with Marfan syndrome developed de-novo leakage after endovascular aneurysm repair of a Dacron graft. Findings at subsequent reoperation suggested that the rebound force on the endograft generated by marked longitudinal deformation in the Dacron graft may have placed stress on the suture line, leading to partial dehiscence. The Dacron graft seemed to provide a stable proximal landing zone. However, the strong tendency of some endograft devices to return to their original shape may apply stress that affected weakened regions of the native aorta.