Amplatzer Device Deployment for Saccular Aortic Arch Aneurysm

Abstract

Amplatzer septal occluder devices (AGA Medical Corporation, Plymouth, MN) have been used in the treatment of saccular and aortic false aneurysms.1,2 We have reservations about the long-term reliability of this approach. A 62-year-old man, who was a heavy smoker and had arteriopathy, was under regular surveillance for chronic obstructive airways disease and bullous emphysema. He had previously undergone abdominal aortic aneurysm resection (1997) with prolonged postoperative respiratory support. Subsequently, a huge circumflex coronary aneurysm (5.9×5.0 cm, Figure 1A) caused lateral myocardial infarction (2005) and an enlarging saccular arch aneurysm (3.5 cm, Figures 1B and 1C, 2 and 3) compressed the pulmonary arterial bifurcation with worsening dyspnea (New York Heart Association class 4). In addition, the coronary angiogram showed severe midvessel left anterior descending stenosis and moderate disease of right coronary artery. Figure 1. A , CT scan in transverse section showing a large circumflex coronary aneurysm (arrow) following covered stent closure of the entry. Diffuse coronary disease is apparent in the LAD branch. B , CT reconstruction demonstrating the nonthrombosed …