Anastomotic Pseudoaneurysm following Surgical Ascending Aortic repair for Acute Type A Dissection
(A) Computed tomography angiogram shows aortic arch pseudoaneurysm at the level of the distal anastomosis.
(B) Three-dimensional reconstruction shows compression on the pulmonary artery.
Figure 2. Six-month computed tomography angiogram control.
(A) Lateral view shows good positioning of the aortic arch endograft with complete exclusion of the pseudoaneurysm.
(B) Three-dimensional reconstruction shows complete aortic arch exclusion and side branch in innominate artery.
A 74-year-old male with a history of chronic obstructive pulmonary disease, smoking, myocardial infarction, right nephrectomy due to cancer, diabetes mellitus, hypertension, and dyslipidemia, underwent replacement of the aortic valve and hemiarch with a button-Bentall operation, with open distal anastomosis for type A acute aortic dissection. The postoperative period was uneventful.
REASON TO TREAT
Predischarge CT angiogram showed a pseudoaneurysm of the left posterolateral side of the ascending aorta at the level of the distal anastomosis. One week later, a new CT angiogram showed significantly increased dimension of the pseudoaneurysm with compression of the pulmonary artery (Fig. 1). Due to the rapid growth of the pseudoaneurysm, and the risk of fistulization into the pulmonary artery, the patient was scheduled for urgent pseudoaneurysm exclusion with NEXUSTM.
A right common carotid artery, left common carotid artery, left subclavian artery bypass was surgically performed and six days later, to allow complete recovery from the bypass surgery, the endovascular procedure was carried out.
NEXUSTM was successfully deployed during an uneventful procedure with an optimal outcome lasting 150 minutes with 42 minutes of fluoroscopy.
Due to an uneventful and minimally invasive procedure, the patient was able to be discharged 7 days post op. Six month follow up CT angiogram (Fig 2) shows stable position of NEXUSTM and total exclusion of the anastomotic pseudoaneurysm.
PHYSICIAN'S PUBLISHED COMMENTS
Cibin et al1 stated “Owing to their ready availability, single- branch off-the-shelf aortic arch endovascular prostheses are a valid option in case of urgent and emergent cases.”
“A combined operation, bypass, and endovascular procedure at the same time, although technically feasible, would be long and with less neurologic control than a staged approach.”
1. Giorgia Cibin, MD, Augusto D’Onofrio, MD, Michele Antonello, MD, Cosimo Guglielmi, MD, Franco Grego, MD, and Gino Gerosa, MD. Bailout Implantation of a New Single-Branch Stent Graft for the
Aortic Arch - Ann Thorac Surg 2020;110:e371-3
University of Padova
Division of Cardiac Surgery and Vascular Surgery
Professor Michele Antonello
Professor Augusto D’Onofrio
Consultant Vascular Surgeon
Consultant Cardiac Surgeon
CAUTION: Investigational Device – Limited by United States law to investigational use. Endospan devices bear the CE marking of conformity.