Volume 98, Issue 7 pp. E985-E989
PVD - Peripheral Vascular Disease

Percutaneous closure of a post-surgical ascending aortic pseudoaneurysm with an amplatzer septal occluder device and steerable guiding sheath

Graham R. McClure MD, MSc

Graham R. McClure MD, MSc

Department of Surgery, McMaster University, Hamilton, Ontario, Canada

Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada

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Geemitha Ratnayake BSc

Geemitha Ratnayake BSc

Michael G Degroote School of Medicine, McMaster University, Hamilton, Ontario, Canada

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Albert Chan MD, MSc

Albert Chan MD, MSc

Department of Medicine, University of British Columbia, New Westminster, British Columbia, Canada

Division of Interventional Cardiology, Royal Columbian Hospital, New Westminster, British Columbia, Canada

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Joel Gagnon MD

Corresponding Author

Joel Gagnon MD

Department of Surgery, University of British Columbia, New Westminster, British Columbia, Canada

Division of Vascular Surgery, Royal Columbian Hospital, New Westminster, British Columbia, Canada

Correspondence

Joel Gagnon, Royal Columbian Hospital, New Westminister, Vancouver Coastal Health, 208-301 Columbia St E, New Westminster, BC V3L3W5, Canada.

Email: [email protected]

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First published: 29 September 2021

Abstract

Thoracic pseudoaneurysm in the ascending aorta is an uncommon condition associated with significant risk of morbidity and mortality. Treatment is recommended in all cases regardless of symptoms as the mortality rate if left untreated has been documented to be as high as 61%. The current standard of care for managing these lesions is open surgical repair. However, this is associated with significant morbidity. In-hospital mortality reported for patients undergoing surgical repair of an ascending aortic pseudoaneurysm ranges from 6.7% to 41%. When anatomically suitable, a less invasive approach using amplatzer vascular plug or septal occluder is an attractive approach. We present a case report of repair of a post-surgical ascending aortic false aneurysm using an amplatzer septal occluder with an Oscor ™ steerable guiding sheath; a novel approach to increase platform stability when engaging an aneurysm neck. Endovascular occluder deployment for closure of aortic false aneurysms remains a relatively novel technique. It is limited by the requirement to develop a stable endovascular platform to deliver the device and avoid system prolapse, particularly when accessing challenging lesions on the inner aortic curvature. We present the first case to utilize a steerable guiding sheath system to improve system stability and facilitate successful device delivery. Given the significant morbidity associated with open repair of these lesions we hope this will further expand the range of lesions viewed as appropriate for endovascular repair.

CONFLICT OF INTEREST

None.

DATA AVAILABILITY STATEMENT

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

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