Percutaneous exclusion of ascending aorta pseudoaneurysms: still an interventional challenge?

Abstract

Ascending aortic pseudoaneurysm is a rare pathology that could have multiple etiologies such as thoracic trauma, infection, and percutaneous or surgical procedures. In patients with aortic pseudoaneurysms, open surgical or endovascular interventions are always indicated, if feasible and independent of size. Several types of endovascular treatment have been reported in the literature, but they have been mostly restricted to those cases when traditional surgery has a prohibitive risk. We report the case of a 75-year-old man with a sinotubular junction pseudoaneurysm, likely developed after coronary artery bypass grafting, which was successfully treated by implanting a multifenestrated cribriform septal occluder, a device already used in few similar cases. <Learning objective: Aortic pseudoaneurysm could be a consequence of several types of aortic injuries. In frail patients endovascular approach represents a viable option instead of surgical repair. Such percutaneous treatment has to be individualized also according to the lesion location and size, as in our case where a sinotubular junction pseudoaneurysm was successfully treated by implanting a multifenestrated cribriform septal occluder.>.

Keywords: Ascending aortic pseudoaneurysm; Atrial septal occluder; High surgical risk.

Fig. 1

Ascending aortic angiography showing pseudoaneurysm of the sinotubular junction before (a), during the delivery of the occluder (b, c), and after its successful exclusion (d).

Fig. 2

Paraxial maximum intensity projection and 3D volume-rendered reconstruction from cardiac computed tomography scan, demonstrating the AAP before (a, b) and after (c, d) the delivery of the device.