Trans-Catheter Aortic Pseudo-Aneurysm Repair

Clinical Presentation 56 year old man with CAD status post 2-vessel CABG and type A aortic dissection status post emergent repair with residual aneurysm presenting with fever, shortness of breath and hemoptysis. Serial BCx (+) for MSSA, TEE showed evidence of enlarging aneurysm with graft leak and question of vegetation. Other Co-Morbidities Hypertension Pulmonary Arterial Hypertension Multiple Sternotomies Anemia Chronic Kidney Disease EtOH Abuse IVDU

Diagnostic Imaging

Pseudo-Aneurysm Exclusion with 6-mm Amplatzer VP4 Closure Device Direct angiography of pseudo-aneurysm sac. Deployment of 6-mm Amplatzer VP4 closure device. Complete Pseudo-aneurysm exclusion.

Hospital Course The patient tolerated his pseudo-aneurysm exclusion with percutaneous placement of an Amplatzer 6-mm VP4 closure device. Placement of the VP4 occluder allowed for patient stabilization and eventual transfer out of the ICU to the general floor. Unfortunately, the patient’s course was complicated by an alternate graft leak causing massive hemoptysis, requiring urgent surgical attention, delaying his eventual discharge to rehabilitation.

Clinical Presentation 61 year old man with CAD status post CABG and ascending aortic aneurysm status post repair presenting with shortness of breath, and accelerating intermittent chest pain radiating to his back. Noted to have aneurysm enlargement, but was not a surgical candidate with a quoted mortality of > 30%. Other Co-Morbidities Hypertension Hyperlipidemia Multiple Prior MIs CHF – NYHA Class III Chronic Kidney Disease COPD Current Tobacco Abuse HIV

Diagnostic Imaging

Pseudo-Aneurysm Exclusion with 24-mm Amplatzer ASD Septal Occluder Aortic root and pseudo-aneurysm sac angiography. Pseudo-aneurysm exclusion. Full deployment of 24-mm Amplatzer ASD Septal Occluder.

Hospital Course The patient tolerated his pseudo-aneurysm exclusion with percutaneous placement of a 24-mm Amplatzer ASD Septal Occluder. Repeat imaging post procedure, and several months later showed continued exclusion and stability of the pseudo-aneurysm sac. Since the time of his procedure, he remains chest pain free.

Summary With the assistance of adequate non-invasive imaging, aortic pseudo-aneurysm characteristics can be easily evaluated allowing for successful exclusion with a variety of percutaneous closure devices. Each case demonstrates the feasibility of percutaneous trans-catheter closure of complicated aortic pseudoaneurysms, particularly in those patients with multiple co-morbidities or those deemed not to be surgical candidates.