Case Study: Minimally Invasive Option for Ascending Aortic Pseudoaneurysm 

Cardiac surgeons at Brigham and Women’s Hospital performed an innovative endovascular procedure to treat a ruptured ascending aortic pseudoaneurysm.

“Minimally invasive procedures are mostly limited to the descending and abdominal aorta, but our team used an endovascular approach to treat a ruptured ascending aortic pseudoaneurysm in a female in her 60s,” says Edwin C. Gravereaux, MD, Vascular Surgical Director of the Aortic Disease Center and Director of Endovascular Surgery.

History

Cardio Figure 1


A female with a history of coronary artery bypass grafting, ascending aortic replacement and aortic valve replacement (2013), presented to the BWH emergency room after an episode of syncope. She was also undergoing chemotherapy for chronic myelogenous leukemia (CML). The patient’s CT scan showed active extravasation from the distal aortic anastomosis (figure 1). Due to the high-risk nature of the case, cardiac surgeons at the Aortic Disease Center elected to try an endovascular option using the abdominal aortic stent graft system, performed through the left axillary artery.

Approach Cardio Figure 2

A 5-cm incision was made at the left axillary in deltopectoral groove, and the axillary artery was identified. Temporary pacing wire was placed from the right femoral vein. Lunderquist wire was placed in the left ventricular apex and the Gore aortic extender prosthesis 36 mm x 4.5 cm was introduced. Two devices were used to seal the aorta. After confirming the location of the point of leak, the endovascular stent graft was deployed (figures 2 and 3).

Cardio Figure 3

Follow-up

A post-procedural CT scan showed no leak or extravasation (figure 4). The patient continues to be treated for her CML, but is doing well from the aortic aneurysm perspective.

The Aortic Disease Center routinely performs procedures that combine cardiac, vascular surgery, endovascular surgery and interventional cardiology, including hybrid aneurysm repair to treat complex aortic and thoracoabdominal disease.

Cardio Figure 4

“The team provides multidisciplinary evaluation and treatment for difficult-to-treat aortic diseases and rapid assessment, triage and treatment for acute aortic emergencies,” says Marc P. Bonaca, MD, MPH, Medical Director of the Aortic Disease Center.

Leave a Reply