Anastomotic Pseudoaneurysm at 30 Years after Thoracic Aorta Surgery

Correspondence To the Editor: We report a strategy for an asymptomatic anastomotic pseudoaneurysm that occurred 30 years after aorta surgery. A 45-year-old male was admitted because the angiograph showed a pseudoaneurysm during an atrial fibrillation radiofrequency procedure. The patient did not have hypertension or chest pain. He had a history of thoracic aorta replacement, which was performed 30 years ago because of a coarctation of the descending aorta. Computed tomography (CT) confirmed the anastomotic pseudoaneurysm [Figure 1]. Consequently, the implantation of a stent-graft was planned to exclude the pseudoaneurysm. This procedure was performed in the catheter laboratory. Local anesthesia was used. The precise location of the leakage of the pseudoaneurysm was identified from the angiograph. A transverse arteriotomy was made on the right femoral artery. The delivery system was introduced with the super-stiff guidewire to the appropriate position. After the systolic blood pressure had been decreased to <100 mmHg, the stent-graft was deployed under fluoroscopy. A second angiograph showed that the shape of the stent-graft was satisfactory. No endoleaks and migration were observed. The patient was discharged uneventfully on the 3 rd day after the endovascular procedure. A CT scan showed the absolute exclusion of the aneurysm [Figure 1] after 3 months of follow-up. Anastomotic pseudoaneurysm is a rare complication following aorta replacement. However, this condition is life-threatening because of the high risk of rupture. This complication has a mortality rate of 61% if no intervention is performed. [1] Its foremost cause may be the high local tension or the edematous aortic wall, which causes sutures to lacerate the aortic wall. Another possible cause is the graft infection. The incidence rate of anastomotic pseudoaneurysm ranges from 0.5% to 15%. To date, two interventions are mainly used to manage this condition: The surgical repair and thoracic endovascular aortic repair. Surgical treatment involves the replacement of a prosthetic graft or direct repair via a redo left lateral thoracotomy. Such redo thoracotomy is extremely difficult because of the adhesion of lungs to the chest wall in the left chest cavity. The high risk of lung injury was reported for more than 30% of the patients. [4] Meanwhile, open surgery has a high mortality rate. Endovascular stent-grafting is a minimal invasive treatment for thoracic aortic disease. Endovascular procedures were recently reported for the treatment of anastomotic pseudoaneurysm. Stent-grafting can be performed under local anesthesia without requiring dissection through the scars of previous operative sites. …