Aortic False Aneurysm Research Articles

False aneurysm of ascending aorta due to pericardial mesothelioma

Ascending aortic false aneurysm is a rare but serious complication of pericardial mesothelioma. We report a case of ascending aortic pseudoaneurysm due to spindle cell pericardial mesothelioma. In this case, the first symptoms of the disease appeared 18 months before surgery. The final diagnosis was determined only when severe late complications occurred. Palliative tumour excision, aortoplasty and aortic valve prosthesis were performed with subsequent adjuvant chemotherapy. Over 10 months after surgery, the patient is alive and a significant reduction of the tumour mass has been achieved. This case demonstrates that timely lifetime diagnosis of malignant pericardial tumour remains very difficult and effective adjuvant chemotherapy is needed to improve the results of surgery.

Amplatzer Device Deployment for Saccular Aortic Arch Aneurysm

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 …

Modified Bentall Procedure Using Two Short Grafts for Coronary Reimplantation: Long-Term Results

The modified Bentall procedure remains a gold standard of aortic root surgery. We present in this study the early and late outcomes of a particular modification using 2 separated grafts for the coronary reimplantation. From 1995 to 2009, 153 patients aged 57±12 (mean±standard deviation [SD]) underwent elective (n=113) or urgent (n=40) aortic root replacement with a composite mechanical valve conduit reconstruction using 2 short, separated 8-mm Dacron grafts for the coronary reimplantation and were retrospectively reviewed. Aortic disease etiologies were annuloaortic ectasia (n=108), type A aortic dissection (n=38), aortic false aneurysm, or Valsalva aneurysm evolution after previous cardiac surgery (n=7). The overall early mortality was 8.5% (20% for urgent procedure and 4.4% for elective procedure). For the whole group, actuarial survival at 5 and 10 years was 86.3%±2.78 and 73.7%±4.23, respectively. Among the 23 late deaths, 9 were valve-related deaths (stroke, n=3; endocarditis, n=1; unknown, n=5). During the follow-up, linearized rates of major bleeding, thromboembolism, and endocarditic evolution were, respectively, 1.3 %/patient-years, 0.42 %/patient-years, and 0.22 %/patient-years. One patient presented a nonseptic false aneurysm of the right coronary anastomosis and no structural valve dysfunction has been diagnosed. In total, only 2 patients required an aortic root reoperation. The modified Bentall procedure using 2 separated grafts for the coronary reimplantation is a feasible, safe, easy, and reproducible operative technique for aortic root surgery.

Aortopulmonary fistula caused by an infected thoracic aortic false aneurysm rupturing after endovascular stent placement

We report a case of 74-year-old man presenting with a rupture of a thoracic aortic false aneurysm after undergoing conventional total arch replacement for aortic arch aneurysm (62 mm) and endovascular stent placement for descending aortic aneurysm (70 mm). His chief complaints at the present admission were fever and sensation of dyspnea and we put him on a course of antibiotics for stent graft infection. However he died of massive hemoptysis. From a standpoint of autopsy findings, a thoracic aortic false aneurysm formed at the just proximal landing zone owing to type Ia endoleak, and simultaneously stent graft infection lead to make fistula formation between the false aneurysm and the lung. We examined ourselves that stent graft infection and aortopulmonary fistula caused by an infected thoracic aortic false aneurysm rupturing into the lung should be promptly treated such as complete removal of the stent and another revascularization in a reasonable period of time except if there are complications such as comorbid1ities or withholding of consent. We experienced and reported one rare case associated with a rupture of thoracic aortic false aneurysm caused by stent graft infection and the fistulization between the lung and the stent graft.

Staged Resternotomy for a Retrosternal Giant Aneurysm of the Thoracic Aorta Using an Inferior T-Shaped Ministernotomy

We describe a staged resternotomy technique using an inferior T-shaped ministernotomy for three redo cases with a retrosternal aortic arch aneurysm. To minimize the disadvantages of resternotomy during closed-chest hypothermia, an inferior T-shaped ministernotomy was performed before approaching the aneurysm. After establishment of the cardiopulmonary bypass with femoral or axillary arterial cannulation, or both, and right atrial drainage, a venting catheter was inserted into the left ventricle and core cooling was induced at 25°C. The retrosternal aneurysm was then exposed by additional superior sternotomy. Under hypotherma with antegrade cerebral perfusion, the distal side of a four-branched graft was anastomosed. During rewarming, reconstruction of the arch vessels and proximal anastomosis of the branched graft were performed. In the 3 patients operated on using this technique, there were no perioperative deaths or serious complications. This suggests that the technique can be safely performed and minimizes the disadvantages of the widely used resternotomy technique.

Airway obstruction by an aortic false aneurysm

Aortic false aneurysms are rare complications of aortic valve replacement and cardiac surgical procedures in general. Aortic false aneurysms can also presents as a mediastinal mass. A false aneurysm etiology should always be considered in mediastinal mass exploration of patients with a cardiac surgery history. Although, a computed tomography (CT) scan can detect a mediastinal mass, it can equally misdiagnose an aneurysm in the absence of tumour contrast enhancement. We present the case of a 60-year-old woman who was hospitalized for a laryngeal dyspnea. She had undergone aortic valve replacement 3 years earlier and had no other relevant medical history. In the last 3 months, she presented a progressively worsening dyspnea and cough. A chest radiograph showed a large mass in the superior mediastinum. A contrast-enhanced CT-scan showed an anterior mediastinal mass (9cm×8cm×9cm) not enhanced by contrast product, suggestive of a tissue density tumour. The mass was in fact an aortic false aneurysm where the communication with the aorta was too narrow to be filled by the contrast product in arterial phase imaging. The aneurysm was excised and successfully replaced with a prosthetic graft during deep hypothermic and circulatory arrest. In this case report, we discuss the unusual clinical presentation of this pseudoaneurysm and the absence of contrast enhancement during CT-scan, which could have lead to a catastrophic error.

Ruptured Tuberculous False Aneurysm of the Abdominal Aorta: A Case Report

Tuberculous false aneurysm of the aorta is rare and has an unpredictable complication of aneurysm rupture. We report a case of a 32-year old woman who was referred to the Department of Vascular Surgery, Avicenne Hospital for severe abdominal pain. Chest x-ray revealed miliary tuberculosis. Contrast enhanced computed tomography (CT) scan showed a false aortic aneurysm involving the juxtarenal aorta. Antituberculous treatment was started because of high presumption of tuberculosis. Five days later, the patient presented with symptoms of aneurysm rupture. She underwent an emergency a surgical resection of the aneurysm with repair of the aortic wall defect by a Dacron Silver patch. The histopathologic examination of the aortic wall showed features of tuberculosis.

Reoperations for Aortic False Aneurysms After Cardiac Surgery

Aortic false aneurysm is a rare complication after cardiac surgery. Aortic dissection, infection, arterial wall degeneration, and poor surgical technique are recognized as risk factors for the occurrence of postsurgical false aneurysm. Despite some recent reports about percutaneous false aneurysm exclusion, a complex surgical reoperation is needed in most of the cases. We retrospectively reviewed our experience in 43 patients who received a reoperation for postsurgical aortic false aneurysm in the last 14 years. Thirty-three patients were male. The mean age was 60 ± 12 years. Most of the patients received prior aortic surgery on the aortic root, the ascending aorta, the aortic arch, and the descending thoracic aorta (38 patients). False aneurysm was diagnosed during follow-up evaluation in the absence of any symptoms in 23 cases. Univariate and multivariate analyses on 18 perioperative variables were performed. In-hospital mortality was 6.9% (3 patients). The postoperative course was complicated in 17 cases (39%). At multivariate analysis, a preoperative history of coronary artery disease and postoperative sepsis were independent risk factors for hospital mortality. Survival rates at 1, 5, and 10 years were 94%, 79%, and 68%, respectively. Freedom from reoperation was 86% at 1 year and 72% at 5 and 10 years. Despite a high postoperative complication rate, a reoperation for postsurgical aortic false aneurysm can be performed with acceptable mortality and good mid-term and long-term outcomes.

Invited Commentary

The treatment pendulum is swinging in many areas of aortic surgery away from open repair toward a less invasive approach using endovascular technologies. However, the current study by Dr Malvindi and colleagues [1Malvindi P.G. van Putte B.P. Heijmen R.H. Schepens M.A.A.M. Morshuis W.J. Reoperations for aortic false aneurysms after cardiac surgery.Ann Thorac Surg. 2010; 90: 1437-1443Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar] demonstrates with regards to the complex subject of reoperation for aortic pseudoaneurysms after prior cardiac operations that open surgical repair remains the most prudent and successful approach. Several factors lead to the development of aortic pseudoaneurysms in patients with a history of cardiac operations; however, it appears that it is becoming a more frequent diagnosis. This study describes 43 cases of aortic pseudoaneurysm in patients with prior cardiac operations over a 14-year period. Many of these patients were asymptomatic at the time of diagnosis, which demonstrates the clinical need for regular computed tomography screening in any patient with a previous aortic operation. In addition, with more high-resolution computed tomography scans being performed, various other focal aortic defects are being identified that may require the same surgical treatment principles as described in their article. One of the most critical aspects of this type of surgical repair is the management of cardiopulmonary bypass cannulation to most safely reenter the chest. Before the chest was opened, 14 patients in this series had initiation of cardiopulmonary bypass and 5 patients in this series needed hypothermic circulatory arrest due to adherence of the aortic pseudoaneurysm to the posterior aspect of the sternum. The authors use the criteria of less than 2 cm of distance between the sternum and the aortic aneurysm on preoperative imaging on when to pursue this approach. Certainly, the excellent outcomes described in this article are directly related to the success of this algorithm. The final important surgical principle that their article highlights is the need for extensive debridement of the pseudoaneurysm and surrounding aortic tissue. One-third of the pseudoaneurysms were related to infection, and 70% of the patient cohort received an aortic graft replacement. Without aggressive repair, these lesions may recur or achieve an inadequate resection. As the authors correctly discuss, endovascular techniques, including hybrid repair, have been described for the treatment of this problem. However, with the excellent surgical outcomes listed in this article, it is difficult to deny patients an open surgical resection. Some patients at high surgical risk may benefit from the less invasive approach, but all of the patients in this study were undergoing redo procedures and had many medical comorbidities. In addition, many of the lesions described in this report were in an unfavorable location for an endovascular approach. Until endovascular technologies advance significantly, an open surgical repair using the principles and techniques listed in this article for aortic pseudoaneurysms in patients with prior cardiac operations should be considered the definitive approach. Reoperations for Aortic False Aneurysms After Cardiac SurgeryThe Annals of Thoracic SurgeryVol. 90Issue 5PreviewAortic false aneurysm is a rare complication after cardiac surgery. Aortic dissection, infection, arterial wall degeneration, and poor surgical technique are recognized as risk factors for the occurrence of postsurgical false aneurysm. Despite some recent reports about percutaneous false aneurysm exclusion, a complex surgical reoperation is needed in most of the cases. Full-Text PDF

Aortic Transection and Diverting Bypass as Treatment of Repetitive Recurrent Abdominal Aortic False Aneurysm Rupture in a Patient With Behcet’s Disease

Abdominal aortic false aneurysms in patients with Behcet's disease have been reported frequently and repaired successfully by various procedures; however, anastomotic false aneurysms have often been reported to occur after the operation. In this article, we report a case of four-time repetitive, recurrent suprarenal abdominal aortic false aneurysm ruptures that lasted for 7 years. The location of this aneurysm was not easy to repair not only by open surgical procedures but by endovascular stent because the aortic defect was too close to the visceral arterial branches. The last operation consisted of primary repair of aortic defect, transection of abdominal aorta at the level of supraceliac aorta with end closure, and a thoracic aorta to abdominal aorta bypass with Dacron graft. An 8-year follow-up revealed no more abdominal aortic aneurysm recurrence.

Midterm Results of Endovascular Repair of Thoracic Aortic False Aneurysm Formation After Coarctation Repair

The aim of this study was to evaluate the short-term and midterm results of endovascular repair of false aneurysm formation after coarctation repair. Between November 1998 and August 2009, seven patients underwent endovascular repair for false aneurysm formation after coarctation repair (two women, five men; mean age: 45.4 ± 12.1 years; range: 30-60 years). Follow-up computed tomography scans were performed at 1 week, 3 months, 6 months, and annually thereafter. All endografts were successfully deployed (Excluder-TAG in three patients, Talent in one patient, Valiant in three patients). Among them, six patients underwent hybrid technique with supra-aortic debranching and simultaneous or staged endovascular stent grafting as follows: transposition of the left common carotid artery (LCCA) into the brachiocephalic trunk which was later followed by transposition of the left subclavian artery into the LCCA in one case and transposition of the left subclavian artery into the LCCA in remaining five cases. No major complications occurred. A mean follow-up of 44.8 ± 41.3 months (range: 1-131 months) demonstrated no endoleak, rupture, conversion, or migration. Short-and mid-term results of endovascular treatment of false aneurysm formation after coarctation repair favor the proposition of endovascular repair as a first-line treatment option. Long-term survival studies are mandatory to determine the efficacy and durability of this technique.

CT-Guided Thrombin Injection to Control Rapid Expansion of Ascending Aortic False Aneurysm 15 Months After Bentall–Bono Operation

We report a case of 57-year-old man treated emergently with CT-guided local thrombin injection as the first, life-saving step for control rapid expansion of the aortic pseudoaneurysm. Fifteen months earlier, he was operated on for ascending aortic true aneurysm and coronary artery disease. Upon admission, he had an anterior thoracic wall pulsatile tumor. Due to critical status, definite surgery was postponed and thrombin was injected close to the origin of pseudoaneurysm. It controlled successfully, bleeding from the ascending aorta and enabled the patient to survive the acute phase.

Computed tomography diagnosis of cardiovascular involvement in Behcet syndrome

Objective To evaluate the computed tomography (CT) characteristics of cardiovascular involvement in Beheet syndrome. Methods Eleven patients with clinically diagnosed Behcet syndrome were studied retrospectively from July 1995 to December 2007. Electron beam CT or 64-slice helical CT scanner was used and CT characteristics were reviewed. Results Eleven patients were diagnosed according to the criteria reported by the international study group for Behcet syndrome. Of them, 4 patients presented with aortic valve prolapse (2 patients with mitral valve prolapse), false aneurysm of right coronary artery was demonstrated in 2 patients, false aneurysm of left subclavian artery, aortic aneurysm and penetrating ulcers, aortic arch false aneurysm, aortic dissection, pulmonary embolism and interatrial scptum aneurysm in 1 case, respectively. Conclusion CT is a very useful method for the diagnosis and foUow-up of Behcet syndrome. Key words: Behcet syndrome ; Aneurysm; Aortic valve insufficiency; Tomography, X-ray computed

Unusual False Aneurysm of the Ascending Aorta Associated with Ruptured Acute Type A Aortic Dissection

False aneurysm of the thoracic aorta unrelated to trauma, or to previous aortic or cardiac surgery, is extremely rare. We encountered a case of ascending aortic false aneurysm formation associated with ruptured acute type A aortic dissection. The false aneurysm, which was contained by thin connective tissue surrounding the aortic wall, was located beside the false lumen of the dissected ascending aorta, expanding toward the transverse sinus. We immediately decided to perform an emergency operation. We noted the large entry site at the anterior wall of the dissected ascending aorta after resection of the flap. We identified the false aneurysm arising from a small tear of the false lumen. Graft replacement of the ascending aorta using a tube graft was performed. The postoperative course was satisfactory. This pathology was believed to be not only a consequence of hemostasis, but also a process of re-rupture of the dissected aorta.

Endovaskuläre Aneurysmaausschaltung nach aortofemoraler Homograftimplantation

We report on two rare endovascular procedures concerning aneurysmatic complications of arterial homografts. In both cases infected aortobifemoral grafts were explanted und replaced by cryopreserved aortofemoral homografts on the left side. The revascularisations on the right side were performed with the deep femoral vein in one case, and by desobliteration of the iliac artery in the other case. After 4 and 10 months, respectively, we found aneurysmatic enlargements of the aortic anastomoses. In both cases we excluded a false aortic aneurysm by uniiliac stentgrafts in combination with a femoro-femoral cross-over bypass for the contralateral leg. Both operations were carried out successfully. However, one patient developed an infection of the stent graft. We explanted the stent graft und performed an aortobifemoral bypass procedure with arterial cryopreserved homograft once again. Both aneurysmatic complications after aortofemoral homograft implantation could be treated successfully by an endovascular approach. Possible late complications caused by the implantation of homografts or by endovascular procedures can be only detected in due time by a follow-up at short intervals.

Reoperation for Aortic False Aneurysms: Our Experience and Strategy for Safe Resternotomy

To review our experience with reoperation for aortic false aneurysms (FA) and to present an analysis of the relevant surgical approaches and risks. From May 1999 to June 2006, 11 patients underwent a total of 13 reoperations due to aortic false aneurysms, with an incidence of 3% of all thoracic aortic cases. Cardiopulmonary bypass (CPB) and cooling were started before sternotomy in all cases. Three different strategies were adopted for patients depending on the position of the FA in the mediastinum as indicated by a preoperative CT scan. These included: deep hypothermic circulatory arrest (18 degrees C), moderate hypothermia (28 degrees C), and mild hypothermia (32 degrees C). In two patients, the sternotomy ruptured the FA causing profuse hemorrhaging. In all the other cases sternotomy was performed without complication. The repair consisted in simple repair by direct suture (10 cases) or extensive repair by refashioning the anastomosis (three cases). Two hospital deaths occurred with a hospital mortality rate of 16.7%. Permanent neurological deficit developed in one patient. Transient neurological deficit in the form of left lower limb weakness was observed in one patient. False aneurysm recurrence developed in two cases. Among patients present at follow-up (nine survivors), four are in NYHA class I and five in class II. Aortic false aneurysms carry a high mortality and morbidity rate. Nevertheless, we believe that selecting the right strategy according to the position of the FA in the chest can reduce surgical risk, thus permitting relatively safe resternotomy.

Management of an aorto-caval fistula from a ruptured aortic false aneurysm using a covered stent graft

An aorto-caval fistula caused by a ruptured false aneurysm of the abdominal aorta was reported. A 70-year-old male who had a history of aorto-femoral bypass was admitted because of right lower abdominal pain. Enhanced computed tomography scans revealed aorto-caval fistula. The patient exhibited high output heart failure and acute renal failure. Stent-grafting for abdominal aorta was performed. Intra- and postoperative examination revealed no leakage from the aorta to the vena cava. Endoluminal treatment for aorto-caval fistula is efficacious as less invasive treatment.

Succesful Embolization Of A Post-Mediastinitis False Aortic Aneurysm

A 71-year-old male patient was admitted with methicillin-resistant staphylococcus aureus mediastinitis two months after coronary artery bypass grafting. Treatment with immediate surgical debridement, removal of sternal wires and use of vacuumassisted closure device was started. Spiral computerized tomography and aortography revealed a false aortic aneurysm at the cannulation site. Active mediastinitis and patient's objection, led us to perform percutaneous coil embolization. No postoperative complication was observed and one year later the patient is in an excellent condition.

A case report; pyogenic spondylitis with false aortic aneurysm

A case report; pyogenic spondylitis with false aortic aneurysm

Hybrid treatment of a symptomatic aortic and left subclavian false aneurysm

1010-7940/$ see front matter Q 2005 Elsevier B.V. All rights reserved. doi:10.1016/j.ejcts.2005.05.024 * Corresponding author. Tel.: C33 3 26 78 71 05; fax: C33 3 26 78 32 73. E-mail address: sru9@neuf.fr (S. Rubin). endoprosthesis after bypasses between the two common carotids and then the left subclavian artery (Fig. 2). Neurological outcome was uneventful. European Journal of Cardio-thoracic Surgery 28 (2005) 491 www.elsevier.com/locate/ejcts