Thoracic Endovascular Aortic Repair for Pseudoaneurysm after Interrupted Aortic Arch Repair

Aortic arch and frozen elephant trunk repair of a right-sided aortic arch with pseudoaneurysm rupture

A 53-year-old man with a history of vascular ring repair secondary to a right-sided aortic arch with a retroesophageal subclavian artery and ligamentum arteriosum to the descending thoracic aorta presented to our institution with a large aortic pseudoaneurysm of the distal aortic arch. Computed tomography demonstrated a right-sided aortic arch with a 5.8-cm pseudoaneurysm arising from the distal arch with concern for rupture. The patient underwent successful two-stage repair, including a left carotid artery to subclavian artery bypass, followed by total arch replacement with the frozen elephant trunk technique. He recovered well postoperatively, and computed tomography showed complete, successful repair of the pseudoaneurysm.

The Importance of TEE Examination in Patients with Pseudoaneurysm of Arch of Aorta Post-TEVAR Procedure

A 57-year-old male patient presented to the emergency department with acute onset severe and tearing pain in the back. He was a chronic smoker and was a known hypertensive. He was admitted in view of type B aortic dissection with entry tear distal to left subclavian artery (LSCA) and underwent thoracic endovascular aortic repair (TEVAR) procedure for the same. Two stents (34–30–200mm size, Ankura, Lifetech, Nanshan District, Shenzhen, China) were placed overlapping each other to cover the dissection flap starting from distal end of left common carotid artery to proximal part of celiac artery. Post-stenting, patient developed recurrent episodes of melena, abdominal distension, and fever that were managed conservatively. Two months later, a routine follow-up computed tomographic aortic angiography revealed a focal contrast filled outpouching (2.1*1.9cm) extending from the proximal part of endovascular stent with surrounding thrombosis from anterior wall of the aortic arch. On inspecting the arch vessels, an ostial occlusion of LSCA was also discovered. Routine blood investigations were all within normal limits. Two-dimensional echocardiography showed a normal biventricular function with concentric left ventricular hypertrophy. All valves were normal.