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OBJECTIVES: To describe successful endovascular management of two ascending aortic pseudoaneurysms, provide short term follow up data, and review the available literature.
METHODS: One patient previously had two aortic valve replacements for endocarditis and was found to have a 7.2 cm pseudoaneurysm and was deemed inoperable. The second patient had a previous CABG/AVR and was incidentally found to have a 1.8 cm pseudoaneurysm on surveillance CTA to follow an AAA. Both patients received high resolution thin cut CTA for optimal procedural planning including the size of the defect, relative position to the coronary arteries, arch vessels and aortic valve. Both pseudoaneurysms were repaired with Amplatzer II plugs from a percutaneous right brachial artery approach to minimize wire manipulation in the aortic arch and stroke risk. A MEDLINE search was performed to evaluate the previous experience with plugs and septal occluder devices in the ascending aorta to compare with reported mortality with open repair.
RESULTS: Both procedures were successful with no intraoperative or perioperative complications. One patient is alive and well ten months later with continued complete occlusion or the pseudoaneurysm neck and near resolution of the pseudoaneurysm cavity. The second patient obtained an excellent result from the procedure with complete occlusion of the pseudoaneurysm; however, he expired 37 days after the procedure due to complications of chronic respiratory failure. Previous reports (n=18) of various closure devices demonstrated 89% procedural success and 1 death during attempted retrieval of a dislodged device.
CONCLUSIONS: Percutaneous closure may be an effective alternative to surgery for ascending aortic pseudoaneurysms, particularly in patients with severe comorbidities portending unacceptable risk of morbidity and mortality with median sternotomy. Continued surveillance is necessary to determine the durability of these repairs.