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      Postoperative ascending aortic gigantic pseudoaneurysm: Endovascular treatment with the use of a septal occluder plug

      case-report

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          Abstract

          A rare postoperative complication of aortic root replacement is pseudoaneurysm formation. Surgical repair may be rather challenging particularly in patients who are elder and with significant comorbidities. Endovascular approach may also be technically demanding, given the high blood velocity and the anatomical challenges of the area of the aortic root and the ascending aorta. We would like to describe a case of an 85-year-old patient with history of prosthetic graft aortic root replacement who had been developed a 7-cm pseudoaneurysm with sternotomy diastasis and extension in the subcutaneous tissue, 7 years after the initial operation. Given the comorbidities, open repair was not considered a valid option and successful endovascular repair with the use of a ventricular septal occluder plug followed. One-year follow-up confirmed satisfactory exclusion of the pseudoaneurysm with no migration of the endovascular device and no other complication. This is one of the rare cases on endovascular repair of an ascending aorta postoperative pseudoaneurysm.

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          Most cited references7

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          Percutaneous closure of ascending aortic pseudoaneurysm using Amplatzer septal occluder device: the first clinical case report and literature review.

          We report the first case of the use of an Amplatzer septal occluder device to close a large ascending aortic pseudoaneurysm. The patient had a complex cardiac history with redo coronary artery bypass graft surgery, severe left ventricular dysfunction, and end-stage renal disease requiring hemodialysis. The procedure was successfully performed under fluoroscopic and 2D/3D transthoracic echocardiographic guidance. Six-week follow-up with both transthoracic echocardiography and MRI showed the device was in proper position with complete closure of the pseudoaneurysm.
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            Intra-arterial thrombin injection of an ascending aortic pseudoaneurysm complicated by transient ischemic attack and rescued with systemic abciximab.

            Thrombin injection as a means of inducing thrombus formation has recently received wide attention as an alternative treatment for pseudoaneurysm. We present a case of a 67-year-old man in whom a large mycotic pseudoaneurysm developed in the ascending aorta because of sternal osteomyelitis and mediastinitis after coronary artery bypass grafting. Transcatheter intra-arterial thrombin injection was performed, and it successfully induced pseudoaneurysm thrombosis. However, the procedure was complicated by a sudden transient ischemic attack caused by thrombus propagation into the cerebral circulation. Complete thrombus dissolution in the cerebral circulation with the resolution of neurologic symptoms was achieved by means of intravenous abciximab.
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              Management of pseudoaneurysm of the ascending aorta performed under circulatory arrest by port-access.

              Pseudoaneurysms of the ascending aorta following previous thoracic surgery pose a difficult surgical management problem. In this report, we present a case of a patient with aortic insufficiency and a pseudoaneurysm of the ascending aorta at the site of a previous anastomosis. The particularity of this case is in the atypical use of Port-Access technology (Heartport, Redwood City, CA) to overcome surgical concerns [1].
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                Author and article information

                Journal
                imas
                IMAS
                Interventional Medicine and Applied Science
                IMAS
                Akadémiai Kiadó (Budapest )
                2061-1617
                2061-5094
                26 September 2018
                December 2018
                : 10
                : 4
                : 213-215
                Affiliations
                [ 1 ]Department of Radiology, Sant’Andrea University Hospital La Sapienza , Rome, Italy
                [ 2 ]Department of Radiology, Cambridge University Hospitals NHS Foundation Trust , Cambridge, UK
                [ 3 ]Department of Cardiac Surgery, Sant’Andrea University Hospital La Sapienza , Rome, Italy
                Author notes
                [* ]Corresponding author: Miltiadis E. Krokidis, MD, PhD, EBIR, FCIRSE, FRCR; Consultant Vascular and Interventional Radiologist, Department of Radiology, Cambridge University Hospitals NHS Trust, Hills Road, CB2 0QQ, Cambridge, UK; Phone: +44 1223 348 920; Fax: +44 1223 217 847; E-mail: mkrokidis@ 123456hotmail.com
                Article
                10.1556/1646.10.2018.41
                6376348
                38063139-0bd0-4b62-be0d-c33b9602a116
                © 2018 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

                History
                : 15 November 2017
                : 08 July 2018
                : 16 July 2018
                Page count
                Figures: 2, Tables: 0, Equations: 0, References: 7, Pages: 3
                Funding
                Funding sources: None.
                Categories
                CASE REPORT

                Medicine,Immunology,Health & Social care,Microbiology & Virology,Infectious disease & Microbiology
                aortic root replacement,ascending aortic pseudoaneurysm,septal occluder plug,endovascular repair

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