Description
The incidence of thoracic aortic aneurysms has been well-documented in patients after surgery for truncus arteriosus communis.1 The patient was a 37-year-old woman with past medical history of truncus arteriosis type I with multiple previous surgeries and sternal infections leading to a complete sternotomy. She presented to our institution with the chief complaint of a bulging, pulsating mass on her chest wall that had developed over 2 weeks. CT scanning showed a 9.2×8.8×10.4 cm pseudoaneurysm (PSA) arising from the tubular portion of the ascending aorta (figure 1). Given the absence of sternum, we decided on a percutaneously approach. An aortic covered stent graft was deployed over the PSA orifice, jailing the JR4 guide catheter, using the left common femoral artery approach. We then advanced a lantern microcatheter through the JR4 into the PSA body. A total of 8 pneumbra coils were deployed into the PSA sac. A single coil then partially embolised in the aorta, via the residual endoleak; hence, a second stent graft was placed to seal the endoleak and the protruding coil in the aorta was snared and removed via the femoral arterial sheath. Repeat CT angiography 1 month after the procedure demonstrated aneurysm thrombosis (figure 2). The patient is at home doing well 3 months postintervention.
Figure 1.
(Panel A) CT scan showing the pseudoaneurysm (PSA) arising off the ascending aorta. (Panel B) 3D reconstruction of the PSA with aortic measurements. (Panel C) Digital Subtraction Angiography (DSA) of the aorta and the PSA.
Figure 2.
(Panel A) DSA showing the deployment of the covered stent graft across the PSA. (Panel B) DSA showing complete exclusion of the PSA with multiple coils and covered stent grafts. (Panel C) Postoperative CT angiography revealing no flow in the PSA. (Panel D) 3D reconstruction showing complete exclusion of the PSA from aortic flow.
Learning points.
In patients with multiple-previous cardiac surgeries the treatment of aortic aneurysm is very complex and very limited data exists for the endovascular repair.2
Here we demonstrate an innovative technique for exclusion of a giant pseudoaneurysm with covered stents and coil embolisation.
Here we demonstrate multimodality approach with endovascular grafts to first exclude the aneurysm, then use coils to thrombose it, so that it becomes less of a rupture risk.
Footnotes
Contributors: HA, AA, CME, VSM: planning and conduct reporting, conception and design, acquisition of data, interpretation of data.
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests: None declared.
Provenance and peer review: Not commissioned; externally peer reviewed.
Patient consent for publication: Obtained.
References
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