1. Trans-Catheter Aortic Pseudo-Aneurysm Repair

2. 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

3. Diagnostic Imaging

4. 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.

5. 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.

6. 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

7. Diagnostic Imaging

8. 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.

9. 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.

10. 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.