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Acute Aortic Syndrome of Ascending Thoracic Aorta: Transcarotid Percutaneous Exclusion of a Ruptured Pseudoaneurysm.

ABSTRACT: Treatment of ascending aorta disease is surgical; however, some series have evaluated the effectiveness of endovascular treatment. We report the case of a patient with a ruptured pseudoaneurysm who underwent endovascular repair via the left common carotid artery. The clinical and neurological evolution was satisfactory during the in-hospital follow-up. (Level of Difficulty: Intermediate.).

SUBMITTER: Eid-Lidt G

PROVIDER: S-EPMC8305088 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Acute Aortic Syndrome of Ascending Thoracic Aorta: Transcarotid Percutaneous Exclusion of a Ruptured Pseudoaneurysm.

Eid-Lidt Guering G Vega Servín Said S Farjat Pasos Julio Iván JI Ramírez Marroquín Samuel S Criales Vera Sergio Andrés SA Gaspar Hernández Jorge J

JACC. Case reports 20201216 15

Treatment of ascending aorta disease is surgical; however, some series have evaluated the effectiveness of endovascular treatment. We report the case of a patient with a ruptured pseudoaneurysm who underwent endovascular repair via the left common carotid artery. The clinical and neurological evolution was satisfactory during the in-hospital follow-up. (<b>Level of Difficulty: Intermediate.</b>). ...[more]

PMID: 34317184

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Project description:Background Penetrating ulcers of aorta, aortic dissections and intramural hematomas all come under acute aortic syndromes and have important similarities and differences. Case report We report a 67?year old man with rupture of a large penetrating ulcer of the distal ascending aorta with hemopericardium and left hemothorax. He underwent interposition graft replacement of ascending aorta and hemi-arch with a 30?mm Gelweave Vascutek graft but represented 6?months later with development of a penetrating ulcer which ruptured into a huge 14?cm pseudoaneurysm. This was repaired with a 28?mm Vascutek Gelseal graft replacement of arch and interposition graft reconstruction of innominate and left common carotid arteries. 6?weeks later, however, he ruptured his proximal descending aorta and underwent TEVAR satisfactorily. Unfortunately, 2?days later, he developed a pathological fracture of left proximal tibia with metastasis from a primary renal cell carcinoma. He died 3?weeks later from respiratory failure. We shall briefly outline the similarities and differences in presentation and management of penetrating aortic ulcers, aortic dissections and intramural haematomas. We shall discuss, in greater detail, penetrating ulcers of thoracic aorta, their natural history, location, complications and management. Conclusion This case report is unique on account of initial successful surgical redressal following rupture of penetrating ulcer of distal ascending aorta into left pleural and pericardial cavities, normally associated with instant death. The haemodynamic effects of the rupture were staggered due to initial contained rupture into a smaller pseudoaneurysm, followed by a further rupture into a false aneurysmal sac followed eventually by generalised rupture into the pleural and pericardial cavities - a unique way of aortic rupture. Further development of another penetrating ulcer and a small pseudoaneurysm in the distal arch 6?months later which further ruptured into a larger 14?cm false aneurysmal sac, which again did not result in exsanguination, is again extraordinarily rare. Thereafter he underwent emergency thoracic endovascular aortic repair (TEVAR) for a further rupture of descending thoracic aorta. All three ruptures were managed successfully and would usually be associated with near-certain death, only for the patient to succumb eventually to the complications of metastatic renal cell carcinoma.

Dataset Information

Acute Aortic Syndrome of Ascending Thoracic Aorta: Transcarotid Percutaneous Exclusion of a Ruptured Pseudoaneurysm.

Publications

Acute Aortic Syndrome of Ascending Thoracic Aorta: Transcarotid Percutaneous Exclusion of a Ruptured Pseudoaneurysm.

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