Context
Pseudoaneurysms of the ascending aorta (PSAA) is a high-risk complication following cardiac surgery.
Surgical repair is the conventional treatment but carries high morbidity and mortality rate.
If left untreated PSA can reach to aortic dissection, thrombosis, distal embolization and fistula
formation. Since 2005, further report show an increasing use of percutaneous technique as an
alternative for PSAA closure in patient ineligible for surgery repair. This method seems to give
promising results.
Objectives
Our aim was to investigate the efficiency and the feasibility of percutaneous treatment to close
ascending aorta pseudonaeurysms and report the existing data concerning this technique to evaluate
the potential generalization for high-risk patient.
Methods
In this work, we examined the literature of percutaneous approach to treat PSAA and sought to
report all cases which have been treat by this technique. We selected patients who underwent
catheter-based intervention with Amplatzer septal occluder technology (ASO) sometimes combined
with coils embolization to close ascending aorta pseudoaneurysm. For each patient, we reviewed the
medical history, the characteristics of the PSAA, the direct result of the intervention and the followup
period.
We also present a serie of four patients involving the use of Amplatzer septal occluder device in
addition, for three cases, with coils embolization, as an alternative strategy in the management of
ascending aorta pseudoaneurysms. All cases were treated in our institution and we used the
Interventional Cardiology Database to retrospectively collect the informations.
Results
Including our cases, percutaneous method shows and efficacity of 84.78% (39/46) with good
midterm follow up outcomes. Coils and Amplatzer occluder device combined technique
demonstrates a similar success rate of 81.81% (9/11). However, rare complications as structure
damage (2.1%(1/46) due to catheter or device embolization (4.5%(2/44)) can appear during
procedure and may have unfortunate outcomes.
Conclusion
This work demonstrates that the percutaneous method is a feasible and effective alternative to treat
patient no eligible for surgery repair. It’s a relatively easy to use technique with shorter time of
hospitalization and better recovery after intervention for the patient. This technical intervention
should be considered for selected patients with high risk for redo sternotomy.