Ascending aorta thoracic endovascular aortic repair for infected pseudoaneurysm

Abstract

A 70-year-old woman with a bioprosthetic aortic valve replacement for aortic valve endocarditis complicated by recurrent endocarditis and requiring homograft aortic root replacement 10 years earlier had presented at 1 month after her admission for pseudomonal bacteremia with right-sided chest pain. An aortic pseudoaneurysm, identified on computed tomography, was treated with an ascending aorta thoracic endovascular aortic repair using two overlapping abdominal aortic stent grafts in the ascending aorta. Postoperative and follow-up imaging demonstrated exclusion of the pseudoaneurysm with stable positioning of the stent grafts. Ascending aorta thoracic endovascular aortic repair can be performed safely with good short-term results in patients presenting with infected pseudoaneurysms of the ascending aorta.

Keywords: Ascending aorta; Infected pseudoaneurysm; TEVAR.

Fig 1

Preoperative computed tomography angiogram (CTA; Left) and computed tomography reconstruction (Right) showing a pseudoaneurysm from the proximal ascending aorta.

Fig 2

Angiogram after deployment of the first stent graft demonstrating continued filling of the pseudoaneurysm.

Fig 3

Predischarge computed tomography angiogram (CTA; Left) and computed tomography reconstruction (Right) showing resolution of pseudoaneurysm after stent graft placement.

Fig 4

Follow-up computed tomography angiogram (CTA; Left) and computed tomography reconstruction (Right) at 4 months demonstrating a decreased mediastinal hematoma, stable stent graft positioning, and no evidence of endoleak.

Fig 5

Follow-up computed tomography angiogram (CTA; Left) and computed tomography reconstruction (Right) at 6 months demonstrating a decreased mediastinal hematoma, stable stent graft positioning, and no evidence of endoleak.