Endovascular Treatment of a Thoracic Aortic Pseudoaneurysm After Previous Open Repair Derek R. Brinster, MD, Desirae M. McKee, MD, Dawn M. Olsen, PA,

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Endovascular Treatment of a Thoracic Aortic Pseudoaneurysm After Previous Open Repair Derek R. Brinster, MD, Desirae M. McKee, MD, Dawn M. Olsen, PA, Scott S. Berman, MD, Julio A. Rodriguez-Lopez, MD The Annals of Thoracic Surgery Volume 82, Issue 1, Pages 308-310 (July 2006) DOI: 10.1016/j.athoracsur.2005.09.075 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 White arrow marks 5 cm × 4 cm × 4 cm pulsatile mass on patient’s left back. Black arrows indicate patient’s previous thoracotomy incision for repair of descending thoracic dissection. The Annals of Thoracic Surgery 2006 82, 308-310DOI: (10.1016/j.athoracsur.2005.09.075) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Preoperative computed tomography scanning. (A) Three-dimensional reconstruction with white arrow pointing to the area of graft kinking and nipple of extravasation and hatched chevron arrow indicating descending thoracic aortic aneurysm. (B) Saggital imaging with white arrow revealing pseudoaneurysm formation and protruding mass and hatched chevron arrow indicating descending thoracic aortic aneurysm. (C) Axial image revealing contrast enhanced imaging of site of pseudoaneurysm with thrombus formation and bony destruction of rib (white arrow). (D) Coronal image revealing kinked area of graft with “nipple” of extravasation surrounded by thrombus (white arrow). The Annals of Thoracic Surgery 2006 82, 308-310DOI: (10.1016/j.athoracsur.2005.09.075) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Operative aortogram. (A) White arrow indicates area of graft kinking and pseudoaneurysm formation. (B) Post-repair: white arrow indicates no pseudoaneurysm and mild correction of kinked graft from previous open repair. The Annals of Thoracic Surgery 2006 82, 308-310DOI: (10.1016/j.athoracsur.2005.09.075) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Postoperative computed tomographic scan reveals (A) successful thoracic aortic stent-graft exclusion of pseudoaneurysm, and (B) successful exclusion of true aneurysm at the level just proximal to the celiac axis. The Annals of Thoracic Surgery 2006 82, 308-310DOI: (10.1016/j.athoracsur.2005.09.075) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions