Aortic Arch Pseudoaneurysm Research Articles

A Complex Case of Ortner’s Syndrome with Emphasis on Peri-TEVAR Procedure Considerations for CVA Prevention

Introduction: Cardiovocal syndrome, or Ortner's syndrome, is a rare condition characterized by hoarseness due to left recurrent laryngeal nerve palsy, typically associated with cardiovascular abnormalities. Case Presentation: We present the case of a 62-year-old male with prolonged hoarseness. A workup revealed a fixed left true vocal cord, and a subsequent chest CT scan demonstrated a large aortic arch pseudoaneurysm, implicating compression of the left recurrent laryngeal nerve. The patient's complex cardiovascular profile included coronary disease and a diminutive right vertebral artery, necessitating a tailored approach to management. Discussion: Despite its benefits, thoracic endovascular aortic repair (TEVAR) carries significant risks, such as stroke and spinal cord ischemia. The decision-making process for revascularization, particularly of the left subclavian artery, remains nuanced and patient-specific, lacking a universal consensus. This case underscores the critical need for comprehensive pre-procedural evaluation, highlights the challenges in managing incidental findings during TEVAR, and emphasizes the importance of individualized patient care.

Long Term Outcomes and Potential Risk Factors for Endovascular Repair of Aortic Pseudoaneurysms in Vascular Behçet’s Disease

This study aimed to analyse long term outcomes and risk factors for endovascular repair of aortic pseudoaneurysms in patients with vascular Behçet's disease (BD). Medical records of 26 aortic vascular BD patients who underwent endovascular treatment at the vascular department of Peking Union Medical College Hospital between January 2002 and December 2021 were reviewed retrospectively. Erythrocyte sedimentation rate (ESR) and C reactive protein were used to assess BD activity. Computed tomography angiography (CTA) was obtained pre- and post-operatively for almost all patients. Univariable logistic regression analysis was used to analyse risk factors for endovascular repair, such as inflammatory indicators, drug usage, and stent graft parameters. The abdominal aorta (n = 17) was the most common site of 27 vascular BD pseudoaneurysms in this study. CTA also revealed one aortic arch pseudoaneurysm, seven descending thoracic aortic pseudoaneurysms, one thoraco-abdominal aortic pseudoaneurysm, and one pseudoaneurysm at the aortic bifurcation. Most of the pseudoaneurysms were treated with covered stent grafts. The technical success rate was 96% and no deaths occurred during hospital stay. The mean follow up was 5.8 ± 5.5 years and 31% (8/26) experienced post-operative complications. Overall one, three, and five year event free survival rates were 87%, 78%, and 74%, respectively. Univariable logistic regression analysis revealed that pre-operative ESR ≥ 16.0 mm/h (p= .040), pre-operative glucocorticoid (GC) use ≤ 11.5 days (p= .024), pre-operative immunosuppressant use ≤ 15.5 days (p= .028), and length of proximal landing zone ≤ 1.95 cm (p= .034) were associated with a worse prognoses following endovascular treatment. Proximal oversize ≥ 9.5% (p= .074) was also regarded as a risk factor, although not statistically significant. This study further confirmed the feasibility of endovascular repair for aortic vascular BD patients. Risk factors predicting poor prognoses included elevated pre-operative ESR, insufficient pre-operative GC use or immunosuppressant use, inadequate proximal landing zone, and larger proximal oversize percentage.

Suspected Mycotic Aneurysm of the Aortic Arch in the Setting of Group B Strep Bacteremia

Mycotic Aneurysms are aneurysms (or pseudoaneurysms) which result from an infectious etiology. Group-B Strep (GBS) associated mycotic aneurysms are exceedingly rare and current literature varies on presentation and diagnostic criteria. This case is a rare presentation of a likely mycotic aortic arch pseudoaneurysm induced from GBS Bacteremia and cervical osteomyelitis in a 60-year-old male.

Recurrent aortic-arch pseudoaneurysm eroding into the left main bronchus following descending thoracic aortic stent repair

BackgroundBehcet's disease is a form of systematic vasculitis that affects vessels of various sizes anywhere in the body. Aortic pseudoaneurysm is the most hazardous lesion in Behcet's disease and is associated with high mortality rate once rupture.Case presentationIn this report, we presented a patient with a known history of Behcet's disease, whose recurrent aortic-arch pseudoaneurysm eroding into the left main bronchus was identified after a 4-year duration of thoracic endovascular aortic repair for thoracic descending aortic pseudoaneurysm ruptured into the left lung. Repeated thoracic endovascular aortic repair combined with the chimney stent effectively controlled massive hemoptysis under the life-threatening circumstance, and the patient was in good condition at the 7-year follow-up.ConclusionsThoracic endovascular aortic repair can be used as an effective and problem-solving treatment approach for thoracic aortic aneurysms eroded into the lung, even recurrent pseudoaneurysm after thoracic endovascular aortic repair in BD patients. Among the imaging methods assessing the technical success, outcome and complications, computed tomography angiography offers a fast, accessible and sensitive imaging modality.

Endovascular repair of aortic arch graft pseudoaneurysm using a duct occluder device with onlay fusion guidance.

Aortic arch pseudoaneurysms can be caused by previous surgery, infection, or trauma. In select patients with small tears and no evidence of infection, local repair can be performed using an open or endovascular technique.1 Open surgical repeat surgery has increased risks and endovascular repair has been especially appealing for the elderly, higher risk patients, and patients with multiple prior procedures.2 We have reported the use of a ductal occluder device in a patient with a large aortic arch pseudoaneurysm.

Evolution and Treatment of Infected Aortic Arch Pseudoaneurysm Associated with Ruptured Mycotic Abdominal Aortic Aneurysm

Evolution and Treatment of Infected Aortic Arch Pseudoaneurysm Associated with Ruptured Mycotic Abdominal Aortic Aneurysm

Single-Vessel Branched Endovascular Repair of an Enlarging Aortic Arch Pseudoaneurysm

Aortic arch pseudoaneurysm is a rare, but serious, complication of aortic dissection with a high risk of rupture. Traditional open surgical intervention has been associated with a high mortality rate (7%-17%). Thoracic endovascular aortic repair (TEVAR) provides a minimally invasive option but requires a 2-cm proximal seal. Advances in device development have led to an increasing body of experience with branched TEVAR (B-TEVAR). These new devices provide a minimally invasive alternative for patients with various types of aortic disease and preserve perfusion to supra-aortic arch vessels.

Off-Pump Open Repair of False Aneurysm of Aortic Isthmus

Pseudoaneurysm is a rare long-term complication following coarctation of aorta repair. Thoracic endovascular aortic repair is the most common approach. However, under some circumstances, this cannot be performed. Therefore, the traditional open approach is indicated. Although the potential ischemia of spinal cord is related to this approach, it remains an efficient alternative. The authors report a case of late pseudoaneurysm of the distal aortic arch following coarctation of aorta repair in a 26-year-old male that has been successfully repaired by left thoracotomy.

Outcomes of Aortic Arch Chimney Technique in a Single Center with 226 Cases

Introduction - To report our single-center experience with chimney technique for aortic arch diseases and the early- and mid-term outcomes in these patients. Methods - From August 2012 to October 2017, 226 patients (mean age 54 ± 12 years; 197 men) with aortic arch diseases underwent thoracic endovascular aortic repair combined with chimney stents. Pathologies included type B aortic dissection (n = 185), aortic arch aneurysm (n = 10), descending thoracic aortic aneurysm (n = 3), aortic arch pseudoaneurysm (n = 2), descending thoracic aortic pseudoaneurysm (n = 8), penetrating aortic ulcer (n = 7), intramural hematoma (n = 7), and aortic rupture (n = 4). Results - The aortic stent-grafts were deployed in zone 0 (n = 22), zone 1 (n = 13), and zone 2 (n = 191). 22 patients in zone 0 received preliminary supra-aortic vessel debranching. A total of 230 chimney stents were deployed (innominate artery, n = 21; right common carotid artery, n = 1; left common carotid artery, n = 13; left subclavian artery, n = 195). The technical success rate was 84% (189/226) and immediate type Ia endoleak occurred in 37 (16%) patients. The 30-day mortality and morbidity was 2% (4/226) and 4% (8/226), respectively. Four major strokes, three spinal cord ischemia and one aortic rupture occurred in the early-term. The mean duration of clinical and imaging follow-up was 22 ± 16 months and 20 ± 14 months, respectively. Late type Ia endoleaks were recorded in two patients. Chimney stent occlusions were recorded in six patients and all were in left subclavian arteries. During follow-up, five patients died due to aortic rupture (n = 3), cerebral hemorrhage (n =1) or rectal cancer (n = 1). Two major strokes occurred, one of them died and the other recovered). One patient received reoperation because of the distal expansion, so the re-intervention rate was 0.5% (1/222). Conclusion - The early and mid-term outcomes from the present study demonstrate that the chimney technique for different zones aortic arch diseases is safe and feasible, but immediate type Ia endoleak should be concerned due to these patients with uncertain late outcomes.

P5609Outcomes of chimney technique for aortic arch diseases: a single-center experience with 226 cases

Abstract Objective The aim of the present study is to report our single-center experience with chimney technique for aortic arch diseases and the early- and mid-term outcomes in these patients. Methods From August 2012 to October 2017, 226 patients (mean age 54±12 years; 197 men) with aortic arch diseases underwent thoracic endovascular aortic repair combined with chimney stents. Pathologies included type B aortic dissection (n=185), aortic arch aneurysm/descending thoracic aortic aneurysm (n=13), aortic arch pseudoaneurysm (n=10), penetrating aortic ulcer (n=7), intramural hematoma (n=7), and aortic rupture (n=4). Results The aortic stent-grafts were deployed in zone 0 (n=22), zone 1 (n=13), and zone 2 (n=191). A total of 230 chimney stents were deployed (innominate artery, n=21; right common carotid artery, n=1; left common carotid artery, n=13; left subclavian artery, n=195). The technical success rate was 84% (189/226) and immediate type Ia endoleak occurred in 37 (16%) patients. In the early-term, four patients died, of which from aortic rupture (n=1), ventricular fibrillation (n=1) or major stroke (n=2). Four major strokes occurred (two patients died and two recovered), but no reintervention was recorded. Spinal cord ischemia developed in three patients. The mean duration of follow-up was 22±16 months. Late type Ia endoleaks were recorded in two patients. Chimney stent occlusions were recorded in six patients. During follow-up, five patients died, of which from aortic rupture (n=3), cerebral hemorrhage (n=1) or rectal cancer (n=1). Two major strokes occurred (one patient died and one recovered) and reintervention performed in one case. Conclusion The chimney technique for aortic arch diseases is safe and feasible. And long-term follow-up observation is needed.

Aortic Arch Pseudoaneurysm Associated With Chronic Trauma by Resected Edge of the Left Clavicle

A 66-year-old man, who had a history of left lung and clavicle resection, was referred to us for aortic arch pseudoaneurysm. Resected edge of the left clavicle was attached to the anterior surface of the aortic arch. Patch repair of the pseudoaneurysm using hypothermic circulatory arrest was performed successfully. (Level of Difficulty: Intermediate.)

Novel Approach to Repairing a Traumatic Aortic Arch Pseudoaneurysm Following a Fall.

Traumatic pseudoaneurysms of the aortic arch are often treated with surgical repair regardless of the lesion size or age. The authors report a simple, less invasive surgical repair in a patient who sustained blunt aortic injury following a fall.

Rare Case of Surgical Treatment of a Giant Aortic Arch False Aneurysm

The authors present a clinical case of a 44-year-old male patient with a chronic giant aortic arch pseudoaneurysm with a diameter of 136 × 72 mm. The open resection of false aneurysm was accomplished without artificial circulation. Repair was performed with temporary ascending-to-descending and brachiocephalic bypass without cardiopulmonary bypass.

Endograft Relining Plus Adjunctive Endoanchors for Disconnection and Migration in Aortic Arch Pseudoaneurysm Hybrid Treatment

Endograft Relining Plus Adjunctive Endoanchors for Disconnection and Migration in Aortic Arch Pseudoaneurysm Hybrid Treatment

An unusual case of shortness of breath: Aortic Arch Pseudo-Aneurysm.

Here In we present a rare case of Shortness of Breath caused by massive trachea deviation due to a giant penetrating atherosclerotic ulcer of the aortic arch that simulates a lung lesion. It is of clinical and educational benefit to highlight the fact that aortic arch masses can grow silently to massive sizes and create mass effect to surrounding organs.

Arteria Lusoria Facilitates Hybrid Management of Aortic Arch Pseudoaneurysm

Classic open ascending aortic replacement is an effective treatment for Stanford type A aortic dissection However it is associated with a mortality ranging between 15 to 60%. This incidence is even higher in recurrent cases. In these patients, hybrid procedures which combine thoracic endovascular aortic repair (TEVAR) with aortic arch vessel bypasses are successfully adopted. This paper reports a successful hybrid management of aortic arch pseudoaneurysm in a 66 year old female patient known to be hypertensive, diabetic,smoker dyslipidemic on dialysis and who underwent one year previously a surgical ascending aortic repair. Aortic arch vessel bypasses -necessary in this case – were facilitated by the presence of an aberrant right subclavian artery known as Arteria Lusoria- This variant, a rare embryologic anomaly of the aortic arch vessels, described by Hunauld in 1735, was used as an inflow artery to the right common carotid allowing the surgeons to avoid a left to right common carotid artery bypass known to be associated with many complications. Although the hybrid management seems a feasible and safe option especially in high risk patients not eligible for open surgical repair, furher clinical studies and development of new devices dedicated to treat ascending aortic diseases are fundamental to improve outcomes.

Endovascular repair of a leaking aortic-arch pseudoaneurysm using graft stent combined with chimney protection to left common carotid artery: Case report and review of literature

Aortic pseudoaneurysm (PsA) is a rare but serious condition that has high mortality and morbidity rates if untreated. We report a rare case of leaking aortic-arch PsA repaired by thoracic endovascular aortic repair using graft stent with the chimney technique to protect the left common carotid artery. Unlike other cases in the literature, our case was unique, having leaking PsA not related to previous cardiac surgery or aortic dissection. The successful management of this patient using thoracic endovascular aortic repair combined with the chimney technique suggests that this approach may be an attractive therapeutic alternative to treat aortic-arch PsA.

EComment: Expanding aortic arch pseudoaneurysm in a high-risk patient with previous coronary surgery: a treatment strategy.

eComment: Expanding aortic arch pseudoaneurysm in a high-risk patient with previous coronary surgery: a treatment strategy.

Challenging treatment of an expanding aortic arch pseudoaneurysm in a high-risk patient with previous coronary surgery.

Challenging treatment of an expanding aortic arch pseudoaneurysm in a high-risk patient with previous coronary surgery.

Ortner’s syndrome: Cardiovocal syndrome caused by aortic arch pseudoaneurysm

72-year-old hypertensive presented with two weeks history of left sided chest pain and hoarseness. Workup demonstrated a pseudoaneurysm in the lesser curvature of the distal aortic arch opposite the origin of the left subclavian artery from a penetrating atherosclerotic ulcer. Following a left carotid-subclavian bypass, endovascular stenting of the aorta was performed excluding the pseudoaneurysm. Patient had excellent angiographic results post-stenting. Follow up at 12weeks demonstrated complete resolution of his symptoms and good stent position with no endo-leak.Ortner’s syndrome describes vocal changes caused by cardiovascular pathology. It should be included in the differential diagnosis of patients with cardiovascular risk factors presenting with hoarseness. This case demonstrates the use of endovascular stents to treat the causative pathology with resolution of symptoms. In expert hands, it represents low risk, minimally invasive therapeutic strategy with excellent early results in patients who are high risk for open procedure.