Endovascular stent-grafting of anastomotic pseudoaneurysms following thoracic aortic surgery

Toshiro Ito, Yoshihiko Kurimoto, Nobuyoshi Kawaharada, Tetsuya Koyanagi, Hitoki Hashiguchi, Akitatsu Yamashita, Yasuko Miyaki, Akihiko Yamauchi, Masanori Nakamura, Tetsuya Higami
General Thoracic and Cardiovascular Surgery 2009, 57 (10): 528-33

PURPOSE: Anastomotic pseudoaneurysm is a rare but life-threatening complication after thoracic aortic surgery. Endovascular stent-grafting is a less invasive treatment for thoracic aortic aneurysm; however, its clinical usefulness for anastomotic pseudoaneurysms following thoracic aortic surgery is unclear.

METHODS: A series of 12 anastomotic pseudoaneurysms in 10 patients, which occurred following thoracic aortic surgery, underwent endovascular stent-grafting in our university hospital. Eight emergent endovascular stent-grafting cases were included in this study. A hand-made stent-graft, reconstructed by suturing graft material to an endoskeleton of modified Gianturco Z stents, was used in all cases.

RESULTS: The delivery success rate was 91.7%, and the hospital mortality rate was 25.0%. Two cases were converted to open surgery during the postoperative phase because of a type I endoleak. Complete absorption or shrinkage of the anastomotic pseudoaneurysm was observed in seven of nine cases.

CONCLUSION: Endovascular stent-grafting for patients with anastomotic pseudoaneurysms of the thoracic aorta following thoracic aortic surgery has become a possible optimal treatment. However, long-term outcome remains unclear, and periodical follow-up is required.


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