McClure Graham R, Ratnayake Geemitha, Chan Albert, Gagnon Joel
Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.
Catheter Cardiovasc Interv. 2021 Dec 1;98(7):E985-E989. doi: 10.1002/ccd.29951. Epub 2021 Sep 29.
Thoracic pseudoaneurysm in the ascending aorta is an uncommon condition associated with significant risk of morbidity and mortality. Treatment is recommended in all cases regardless of symptoms as the mortality rate if left untreated has been documented to be as high as 61%. The current standard of care for managing these lesions is open surgical repair. However, this is associated with significant morbidity. In-hospital mortality reported for patients undergoing surgical repair of an ascending aortic pseudoaneurysm ranges from 6.7% to 41%. When anatomically suitable, a less invasive approach using amplatzer vascular plug or septal occluder is an attractive approach. We present a case report of repair of a post-surgical ascending aortic false aneurysm using an amplatzer septal occluder with an Oscor ™ steerable guiding sheath; a novel approach to increase platform stability when engaging an aneurysm neck. Endovascular occluder deployment for closure of aortic false aneurysms remains a relatively novel technique. It is limited by the requirement to develop a stable endovascular platform to deliver the device and avoid system prolapse, particularly when accessing challenging lesions on the inner aortic curvature. We present the first case to utilize a steerable guiding sheath system to improve system stability and facilitate successful device delivery. Given the significant morbidity associated with open repair of these lesions we hope this will further expand the range of lesions viewed as appropriate for endovascular repair.
升主动脉胸段假性动脉瘤是一种罕见疾病，具有较高的发病和死亡风险。无论有无症状，所有病例均建议进行治疗，因为文献记载未经治疗的死亡率高达61%。目前治疗这些病变的标准方法是开放手术修复。然而，这会带来较高的发病率。接受升主动脉假性动脉瘤手术修复患者的院内死亡率在6.7%至41%之间。在解剖结构合适时，使用Amplatzer血管封堵器或房间隔封堵器的微创方法是一种有吸引力的方法。我们报告一例使用带有Oscor™可控导引导管鞘的Amplatzer房间隔封堵器修复术后升主动脉假性动脉瘤的病例；这是一种在封堵瘤颈时增加平台稳定性的新方法。用于闭合主动脉假性动脉瘤的血管内封堵器置入仍是一项相对较新的技术。它受到需要建立稳定的血管内平台以输送装置并避免系统脱垂的限制，特别是在处理主动脉内弯处具有挑战性的病变时。我们报告首例利用可控导引导管鞘系统提高系统稳定性并促进装置成功输送的病例。鉴于这些病变开放修复相关的高发病率，我们希望这将进一步扩大被视为适合血管内修复的病变范围。
