Rupture Of Pseudoaneurysm Research Articles

S2599 Gastroduodenal Artery Aneurysm: When Endoscopy Is Not the Answer

Introduction: Gastroduodenal artery aneurysms (GDAAs) are rare with high mortality rate. We present a patient with massive gastrointestinal (GI) bleeding found to have gastroduodenal artery pseudoaneurysm. Case Description/Methods: A 75-year-old woman with hypertension, diabetes, sleep apnea, and prior stroke presented with fatigue, nausea, and decreased appetite. Vital signs and physical exam were normal. Hemoglobin (Hgb) was 13.2 grams per deciliter (g/dl). Nine days later, she developed abdominal pain and melena. Vital signs and physical exam were normal, Hgb was 11.8 g/dl, and computed tomography angiography (CTA) was normal. Esophagogastroduodenoscopy (EGD) showed duodenal ulcer with visible vessel, treated with epinephrine injection (epi) and hemoclips. Melena recurred eleven days later. Repeat EGD showed duodenal bleeding with poor visibility, prompting transfer to our hospital. EGD at our facility showed hemi-circumferential deep ulcer and arterial spurting in the distal duodenal bulb, treated with epi and hemoclips resulting in initial hemostasis but then continued bleeding (Figure 1A). She developed pulseless electrical activity arrest but was resuscitated. Mesenteric angiogram showed a 0.8 × 0.8 centimeter distal gastroduodenal artery pseudoaneurysm with extravasation requiring embolization with 2-4 millimeter interlock coils (Figure 1B). There was no further bleeding and she was discharged. Discussion: GDAAs account for 1.5% of visceral arterial aneurysms, which include true aneurysms and pseudoaneurysms (PAs). True aneurysms arise from vessel wall abnormalities such as degenerative or atherosclerotic processes, fibromuscular dysplasia, or collagen vascular diseases. PAs arise from vascular insults such as trauma, iatrogenic injury, or inflammation. The risk of GDAA PA rupture is as high as 75%. GDAAs may be asymptomatic or present as GI bleeding, abdominal pain, gastric outlet obstruction, or a pulsatile abdominal mass. CTA is the initial imaging of choice given high sensitivity, availability, and promptness. Mesenteric angiography is the diagnostic gold standard and allows for therapeutic intervention with endovascular embolization, which has superior outcomes compared to open surgical ligation. Follow-up imaging is necessary to look for aneurysm reperfusion, seen in 9-15% of cases. GDAA rupture is a difficult yet crucial diagnosis to make given mortality rate up to 21%.Figure 1.: A, Duodenal ulcer with actively spurting visible vessel. B, Mesenteric angiogram shows gastroduodenal artery pseudoaneurysm with extravasation of contrast (black arrow).

Ruptured ileocolic artery pseudoaneurysm after laparoscopic appendectomy for acute appendicitis

BackgroundA pseudoaneurysm of the splanchnic vessels is considered to be rare, and in particular, very few cases of pseudoaneurysm in the ileocolic artery are reported. Here, we report a case of rupture of a pseudoaneurysm of the appendicular branch of the ileocolic artery after laparoscopic appendectomy.Case presentationA 52-year-old man was diagnosed as having phlegmonous appendicitis, and an emergency laparoscopic appendectomy was performed. Bleeding from the inter-appendicular ligament during detachment of adhesions was stopped by white coagulation and Z-suture, and the inter-appendicular ligament was treated. The postoperative course was uneventful, and there were no adverse events or findings suggestive of abscess formation. On postoperative day 30, he presented with a ruptured pseudoaneurysm of the appendicular branch of the ileocolic artery. A definitive diagnosis was made by computed tomography, and emergency interventional radiology was performed with hemostasis achieved by coiling. The patient’s postprocedure course was favorable, and he was discharged with no adverse events, such as intestinal ischemia.ConclusionsWe experienced a case of delayed pseudoaneurysm rupture after laparoscopic appendectomy. Care must be taken when handling the appendicular artery during the procedure, and the potential for pseudoaneurysm formation should be considered at postoperative follow-up.

Spontaneous rupture of an intratumoral pseudoaneurysm in a giant renal angiomyolipoma

We reported a rare case of a spontaneous rupture of an intratumoral pseudoaneurysm in a giant renal angiomyolipoma of a 52-year-old lady. The initial presentation was a sudden onset of right hypochondriac pain, nausea, and vomiting. CT scan revealed large heterogenous exophytic enhancing mass with mixed solid and fat density within, arising from the right kidney likely represent a giant right renal angiomyolipoma. There is associated right perinephric hematoma and active bleeding within the mass. No features suggestive of tuberous sclerosis. Subsequent right renal angiogram revealed a pseudoaneurysm of an inferior segmental right renal artery and emergency embolization was done with successful obliteration of the aneurysmal sac and devascularization of the mass.

Long-Term Incidence and Timing of Splenic Pseudoaneurysm Formation after Blunt Splenic Injury: A Descriptive Study

Nonoperative management (NOM) has become a standard strategy for hemodynamically stable patients with blunt splenic injury; however, delayed rupture of splenic pseudoaneurysm (SPA) is a serious complication of NOM. In medical literature, data regarding the long-term incidence of SPA are scarce, and the appropriate timing for performing follow-up contrast-enhanced computed tomography (CT) has not yet been reported. This study aimed to elucidate the long-term incidence and timing of SPA formation after blunt splenic injury in patients treated with NOM. This descriptive study was conducted at a tertiary medical center in Japan. Patients with blunt splenic injury who were treated with NOM between April 2014 and August 2020 were included in the analysis. Included patients underwent repeated contrast-enhanced CT to detect SPA formation. The primary outcome was the cumulative incidence of delayed formation of SPA. We also evaluated differences in SPA formation between patients who received transcatheter arterial embolization (TAE; TAE group) and those who did not receive it (non-TAE group) on admission day. Among 49 patients with blunt splenic injury who were treated with NOM, 5 patients (10.2%) had delayed formation of SPA. All cases of SPA formation occurred within 15days of injury. The incidence of SPA formation was not significantly different between the TAE and non-TAE groups (1/19 vs. 4/30, P=0.67). SPA developed in 10% of patients within approximately 2weeks after blunt splenic injury. Therefore, performing follow-up contrast-enhanced CT in this period after injury may be useful to evaluate delayed formation of SPA. Although our findings are novel, they should be confirmed through future studies with larger sample sizes.

A case of Mirizzi syndrome accompanied by a pseudoaneurysm that ruptured into the gallbladder: successfully treated by embolization of aneurysm and sequential surgery

BackgroundAlthough visceral aneurysms are relatively rare, it can be life-threatening in case it ruptures. We report a case of Mirizzi syndrome accompanied by a pseudoaneurysm that ruptured into the gallbladder.Case presentationThe patient was a 73-year-old woman with persistent gastrointestinal bleeding and progressive jaundice. Examination revealed a pseudoaneurysm in the gallbladder artery or hepatic artery branch, and biliary hemorrhage due to gallbladder perforation was suspected. Urgent abdominal angiography revealed a pseudoaneurysm measuring 50 × 32 mm that had ruptured directly from the right hepatic artery or the cystic artery into the gallbladder. The pseudoaneurysm was successfully coiled and the bleeding was stopped. The presence of ongoing obstruction due to Mirizzi syndrome resulted in an emergency cholecystectomy being performed on the same day. On removing the impacted gallstone from the neck of the gallbladder, we found an obstruction between the lateral wall of the common bile duct and the gallbladder, this condition was diagnosed as Mirizzi syndrome with a biliobiliary fistula. After removing the impacted gallstone, a T-tube was inserted into the common bile duct. Bile leakage was observed postoperatively, but it improved with drainage. The patient fully recovered.ConclusionsWe present our experience with a case of Mirizzi syndrome accompanied by a ruptured pseudoaneurysm successfully treated with coil embolization followed by cholecystectomy. In this case, the pseudoaneurysm may have been caused by inflammation due to cholecystitis or compression of the arterial wall by a gallstone. To the best of our knowledge, Mirizzi syndrome associated with pseudoaneurysm rupture is rare. Our study suggested that cholecystectomy preceded by transcatheter arterial embolization is an effective strategy to control bleeding in patients with hemobilia due to aneurysm.

Endovascular and Hybrid Repair in Patients with Heritable Thoracic Aortic Disease

In individuals with heritable thoracic aortic disease (HTAD), endovascular repair for treatment of aortic aneurysm and dissection may be lifesaving, but is associated with increased risk of failure of endovascular repair and adverse outcomes. This study reports our experience with early and late outcomes of endovascular aortic and branch vessel repair in patients with HTAD. A retrospective case series was performed by chart review of individuals with HTAD followed at Washington University School of Medicine/Barnes-Jewish Hospital who underwent endovascular aortic and/or branch vessel repair. Clinical features, imaging characteristics, and short- and long-term outcomes were collected. Twenty-nine patients with HTAD (20 male; mean age 45±13years) underwent 37 endovascular procedures between 2006 and 2020 with mean follow up of 54±41months. Seven patients underwent two or more separate endovascular procedures. Each procedure was considered separate for data collection and analysis. Underlying conditions included Marfan syndrome (n=16 procedures), Loeys-Dietz syndrome (n=14 procedures), vascular Ehlers-Danlos syndrome (n=3 procedures), and nonsyndromic HTAD (n=4 procedures). Twenty patients (69%) had prior open surgical aortic repair. Indications for endovascular aortic repair (n=31) included urgent repairs of acute complications of aortic dissection (n=10) or aneurysm rupture (n=3), and elective aortic repair (n=18; 10 chronic dissections and eight chronic aneurysms). Six patients underwent elective endovascular repair of six branch vessel aneurysms or dissections. Six patients underwent hybrid open surgical and endovascular repair. Of the 37 procedures, 25 (68%) proximal landing zones were in the native aorta or branch vessel, 11 (30%) were in a surgical graft or elephant trunk and one was in a previously placed endograft. Thirty-six (97%) procedures were technically successful, and none required emergency surgical conversion. Two patients died: one from sepsis and one from presumed late pseudoaneurysm rupture, for a 5% per-procedure mortality rate. Two procedures were complicated by stroke and one patient developed paraparesis. Of the 31 aortic procedures, seven aortic endografts (23%) developed a stent-induced new entry (SINE) discovered with imaging at 20±15days post-procedure. Seven endografts (23%) developed a Type I endoleak and eight (26%) developed a Type II endoleak. No Type III endoleaks were seen. Within 30days, two endografts (of 37, 5%) required reintervention. After 30days, fifteen additional endografts (of 37, 41%) required reintervention. Two patients (of 6, 33%) who underwent hybrid repair required reintervention. This study is the largest single-center case series examining outcomes of HTAD patients following endovascular repair. Urgent and elective endovascular repairs in patients with HTAD can manage acute and chronic complications of aortic aneurysm and dissection with relatively low risk. However, risk of early and late endoleaks and SINE is high. Close post-procedural surveillance is required, and many individuals will require additional interventions. Hybrid repair shows promise and requires further investigation.

Iatrogenic pulmonary pseudoaneurysm rupture following thoracic drainage

Iatrogenic pulmonary pseudoaneurysm rupture following thoracic drainage

Left ventricular pseudoaneurysm: the niche of post-infarction mechanical complications.

Left ventricular pseudoaneurysm (LVP) is a very rare, but potentially lethal mechanical complication of acute myocardial infarction (AMI). Despite representing a unique subset of cardiac rupture, it presents peculiar features that distinguish it from both ventricular free-wall rupture (FWR) and ventricular true aneurysm. LVP occurs in less than 0.5% of patients affected by AMI. However, LVP is generally burdened by high mortality, often related to false cavity rupture, leading to catastrophic and often irreversible consequences. The risk of rupture is inversely proportional to the timing from AMI onset, which also determines both the classification of LVP and drives the indication for treatment. Despite the lack of a current consensus on LVP management, urgent surgery is the treatment of choice for LVPs occurring within 3 months from AMI, especially if larger than 3 cm in diameter. A matter of debate, however, is represented by chronic LVPs, especially because the risk of rupture decreases progressively as time passes and left ventricular (LV) false cavity stabilizes. Surgical mortality rate remains not negligible (more than 20%), but these suboptimal results may be considered acceptable, especially considering the lethality associated with the occurrence of pseudoaneurysm rupture. Diagnostic workup is essential for anatomical characterization of LV rupture, which is mandatory to guide the decision on surgical approach and technique for pseudoaneurysm repair. Finally, for a subset of patients with anterior LVP and a well-defined fibrotic neck, and deemed at excessively high surgical risk, percutaneous closure of the cavity has been described with encouraging results.

Hybrid Repair for Acute Aorto-Pulmonary Fistula Following Coarctation Repair

Pseudoaneurysm is an infrequent complication of aortic coarctation repair. It occurs in 5-9% of patients. Further complications such as pseudoaneurysm rupture or aorto-pulmonary fistula (APF) carry a high mortality rate and represent a therapeutical.

Coil embolization of ruptured distal renal artery pseudoaneurysm with gross hematuria and hemorrhagic shock

Renal artery pseudoaneurysms have been infrequently reported in the literature. In the present report, we have described a case of a ruptured renal artery pseudoaneurysm requiring coil embolization. A 49-year-old man had presented to our institution with a hypertensive emergency. Computed tomography revealed a 3.4-cm right renal artery pseudoaneurysm. Nonemergent coil embolization was planned for the following day. However, he became hypotensive, exsanguinating frank blood from the urethra. An arteriogram showed extravasation of contrast into the pseudoaneurysm sac, renal pelvis, and ureter, consistent with intrarenal pseudoaneurysm rupture. We have demonstrated coil embolization as a method of repairing a ruptured renal artery pseudoaneurysm with gross hematuria.

Haemosuccus pancreaticus: a diagnostic challenge and its management through interventional radiology

BackgroundHaemosuccus pancreaticus (HP), also known as pseudohaemobilia, is defined as upper gastrointestinal tract hemorrhage originating from the pancreatic duct into the duodenum via the ampulla of Vater or major pancreatic papilla. Pseudoaneurysm formation from the splenic artery is a common complication of pancreatitis; however, upper gastrointestinal bleed resulting from rupture of splenic artery pseudoaneurysm into the pancreatic duct is unusual and challenging to diagnose.Case presentationA 26-year-old patient presented with multiple episodes of hematemesis, melena, and intermittent abdominal pain. A contrast-enhanced computed tomography (CECT) scan was performed that demonstrated chronic calcific pancreatitis with a pseudoaneurysm in the splenic artery in close relation to the main pancreatic duct. The patient was immediately shifted for endovascular management, and the pseudoaneurysm was successfully embolized. Post embolization, the patient developed splenic abscess, which was managed by percutaneous catheter drainage.ConclusionDue to its rarity and being challenging to diagnose, the mortality rate of HP is high. A high level of expertise is required to diagnose HP, and it should be considered in all upper gastrointestinal bleed patients associated with acute or chronic pancreatitis. Rapid initial CECT and angiography should be performed to confirm the diagnosis, followed by embolization of the bleeding pseudoaneurysm to eliminate the need for surgery. This case report highlights the challenges in the diagnosis and management of HP.

Pseudoaneurysm bleed in chronic pancreatitis: beware of multiple feeding vessels-a case report

Gastroduodenal artery (GDA) pseudoaneurysm is a rare but potentially fatal complication in chronic pancreatitis. Managing GI bleed in chronic pseudocyst due to ruptured pseudoaneurysm having multiple feeding vessels and that too in a background of portal hypertension is a challenging task. A 43 year old male patient with chronic calcific pancreatitis presented to our department with 10 days history of malena and drop in hemoglobin. He under micro coil embolization of GDA 12 days before in another hospital for ruptured GDA pseudoaneurysm with upper GI bleed. Upper GI endoscopy revealed grade II-III esophageal varices with portal hypertensive gastropathy with blood in 2nd part of duodenum. CECT scan revealed features of chronic calcific pancreatitis with pseudocyst and GDA pseudoaneurysm with intracystic bleed. Patient again underwent coil embolization in our hospital. However, the patient again developed GI bleed. Patient was taken for emergency laparotomy and found to have bleed from splenic artery as well as GDA pseudoaneurysm into the pseudocyst. Transcystic pseudoaneurysm ligation with ligation of intracystic bleeding vessels and lateral pancreaticojejunostomy was done. Postoperatively patient recovered well. Rupture of pseudoaneurysm in chronic pancreatitis is associated with almost 100% mortality if untreated. Though radiological intervention should be the primary modality of treatment, low threshold for surgery should be kept, considering multiple feeding vessels to the pseudocyst pseudoaneurysm, which may be missed in angiography

Clinical Features and Treatment Outcomes of Pseudoaneurysm Following Pancreatic Resection.

Management strategies for pseudoaneurysm rupture after pancreatic resection have not yet been firmly established due to its low incidence and effects of environmental variability among centers. This study aimed to provide a basis for treatment strategy improvement. Clinical features and outcomes of 29 patients who experienced pseudoaneurysm formation or rupture following pancreatic resection were retrospectively reviewed. The incidence of pseudoaneurysm formation was 2.8%. In 28 of 29 patients, pseudoaneurysm was identified via emergent dynamic computed tomography (CT). The rates of complete cessation of bleeding by interventional radiology (IVR) and surgical intervention were 88% and 100%, respectively. Mortality rate was 13.8%. Four patients treated by IVR died, including three of massive bleeding and one of liver failure. Patients with suspected pseudoaneurysm rupture after pancreatic resection should undergo immediate CT. Open surgery is preferable for patients with incomplete hemostasis by IVR or those who cannot immediately undergo IVR, however, IVR is an effective alternative.

In situ reconstruction of ruptured mycotic iliac artery aneurysm with autologous fascial-peritoneal tissue: a case report and literature review

BackgroundInfectious aneurysms are rare in clinic with poor therapeutic outcomes. When artery rupture occurs, the disease tends to progress resulting in a high mortality, and there remains no ideal treatment.Case presentationWe report a case of rupture of infectious iliac artery pseudoaneurysm, who was assigned to receive artery reconstruction with autologous fascial-peritoneal tissue and obtained satisfied short-term outcome. The follow-up of 6 months after operation was good and long-term follow-up is continuing.ConclusionThe posterior rectus fascia-peritoneal layer seems to be a feasible autologous biomaterial for vascular substitution in urgent setting when no other autologous material was available.

Endovascular Repair In Patients With Heritable Thoracic Aortic Disease

<h3>INTRODUCTION AND OBJECTIVES</h3> In patients with heritable thoracic aortic disease (HTAD), endovascular repair of aortic aneurysm and dissection may be lifesaving but is associated with increased risk of complications. This study reports our experience with endovascular aortic and branch vessel repair in patients with HTAD. <h3>METHODS</h3> A retrospective analysis of patients with HTAD at our institution who underwent endovascular aortic and/or branch vessel repair was performed. <h3>RESULTS</h3> Twenty-nine patients with HTAD (20 male; mean age 45 ± 13 years) underwent 37 endovascular procedures between 2006-2020. Indications for repair were acute complications of aortic dissection (n=10) or aneurysm rupture (n=3), and elective aortic repair (n=18; 10 chronic dissections and 8 chronic aneurysms). Six procedures repaired branch vessel aneurysms or dissections. Twenty-five (68%) proximal landing zones were in the native vessel, 11 (30%) were in a surgical graft or elephant trunk and 1 was in an endograft. Outcomes are listed in Table I. Thirty-six (97%) procedures were technically successful and none required surgical conversion. Two patients (7%) died: one from sepsis (33 days post-procedure) and one from presumed pseudoaneurysm rupture (116 days post-procedure). Two procedures were complicated by stroke and one patient developed paraparesis. Six aortic endografts (16%) developed stent-induced new entry tears (SINEs) identified 20 ± 15 days post-procedure. Seven endografts (19%) developed a Type I endoleak and 9 (24%) developed a Type II endoleak. Within 30 days, 2 (5%) endografts required reintervention. After 30 days, 15 additional endografts (41%) required reintervention. <h3>CONCLUSIONS</h3> Endovascular repair in select patients with HTAD can manage acute and chronic complications of aortic aneurysm and dissection at relatively low risk. However, risk of endoleaks, SINEs, and reinterventions is high.

Femoral Mycotic Pseudoaneurysm Rupture by Salmonella

Femoral Mycotic Pseudoaneurysm Rupture by Salmonella

INTRACRANIAL EMBOLIZATION: A RARE COMPLICATION

We report a case of a rare complication: aortic pseudoaneurysm rupture after embolization of an intracranial aneurysm in a 62 –year- old patient with spontaneous subarachnoid hemorrhage, presented with chest pain and shortness of breath the fourth day after the procedure. The intracranial aneurysm was embolized with no intraoperative complications, and a postprocedural CT (computed tomography) scan showed no signs of intracranial rebleeding, ischemic lesions, or hydrocephalus. Cardiosurgical treatment was not indicated for the aortic pseudoaneurysm rupture.

A rare case of spontaneous rupture of renal artery pseudoaneurysm in a previously hypertensive patient

Introduction. The renal artery and segmental renal artery pseudoaneurysm is a rare and usually asymptomatic vascular lesion which in most of the cases thrombose spontaneously, but at same time it can be a source of life-threatening hemorrhage and shock. Today, these pseudoaneurysms are discovered with increasing frequency due to unrelated abdominal imaging or on screening work-ups for hypertension, as well as widespread use of angiography. Typically, they are seen in patients after trauma, inflammation, or renal surgery or biopsy. Case outline. In our case, a 52-year-old male patient with no prior history of surgery, significant abdominal trauma and systemic disease, presented with left flank pain and signs of hypovolemic shock that manifested before the admission to the surgical emergency room. The CT scan promptly demonstrated rupture of a large retroperitoneal hematoma with massive intraperitoneal hemorrhage. The angiography confirmed the rupture of the renal artery pseudoaneurysm. The patient underwent urgent operation. A life-saving nephrectomy was performed while intraperitoneal hemorrhage and retroperitoneal hematoma was evacuated. Fourteen days after surgery the patient was discharged fully recovered, with normal diuresis and serum levels of creatinine and urea within referential values. During the period of hospitalization, he was diagnosed with and treated for hypertension. Conclusion. Rupture of pseudoaneurysms followed by hemorrhage into the intraperitoneal cavity and retroperitoneum is a life-threatening condition, as proven with this case, in which hypovolemic shock manifested itself before the admission. We would like to highlight the importance of high blood pressure control and the importance of regular check-ups.

Spontaneous Rupture of Splenic Artery Pseudoaneurysm into Walled-off Pancreatic Necrosis – A Rare Cause of Recurrent Hematochezia

Splenic artery pseudoaneurysm rupturing into walled-off pancreatic necrosis and manifesting as hematochezia is very uncommon. We report one such unusual presentation. A 36-year-old man presented with recurrent episodes of hematochezia requiring multiple blood transfusions in 2 months. Upper and lower gastrointestinal endoscopy ruled out any source of the bleed. CT angiography revealed pseudoaneurysm from the splenic artery leading onto a walled-off pancreatic necrotic collection; the collection had fistulous communication to the colon. The aneurysm was coil embolized and he was discharged in a clinically stable state.

Long-term outcomes of endovascular treatment for aortic pseudoaneurysm in patients with Behçet's disease.

Behçet's disease (BD) is a multisystem inflammatory disorder with unknown etiology, and its aneurysmal lesions are associated with high mortality due to the high risk of rupture. This study intended to further explore the long-term safety and efficacy of endovascular therapy for BD-related aortic pseudoaneurysm (BAP). From January 2009 to May 2021, 17 BAP patients who underwent endovascular repair were retrospectively identified and enrolled. Adequate immunosuppressive treatment was instituted before and after endovascular treatment unless emergency surgery was required. The patients were followed up at 3, 6, and 12 months and yearly after the primary endovascular intervention by computed tomography angiography (CTA) examination. Nineteen BAPs were identified among 17 patients. BAPs located at the aortic arch were found in three patients (17.6%), descending thoracic aorta in 5 (29.4%), and abdominal aorta in 10 (58.8%; suprarenal abdominal aorta in 2 [11.8%], and infrarenal abdominal aorta in 8 [47.1%]). The mean ESR during admission was 56.5 ± 24.9mm/h (range = 30.0-120.0mm/h), which fell to 22.7 ± 18.4mm/h (range = 2.0-74.0mm/h) before the endovascular intervention (p < 0.001). The rate of favorable immunosuppressive control before intervention is 76.5% (13/17). Technical success was achieved in all patients. Median follow-up time was 57.0months (interquartile range [IQR] = 21.3-67.3months). Pseudoaneurysm recurrence was observed in four patients, type I endoleak in one, pseudoaneurysms sac dilation in one, and external iliac artery occlusion in 1. Two patients died of pseudoaneurysm rupture. Five-year accumulated overall rate, recurrence-free rate, and reintervention-free survival rate of BAP patients were 92.8%, 75.4%, and 71.8%, respectively. Endovascular treatment in BAP patients seemed to be associated with long-term safety and efficacy with a 5-year overall survival rate of 92.8%. Adequate immunosuppressive treatment was essential for BAP patients to prevent aortic pseudoaneurysm recurrence and improve the prognosis.