Endovascular repair of ascending aortic pseudoaneurysm: technical considerations of a common carotid artery approach using the Zenith aortic cuff endograft.
OBJECTIVE
To present a technique for endovascular treatment using Zenith aortic cuff extenders delivered via a left common carotid artery (CCA) approach in a patient with a large symptomatic ascending aortic pseudoaneurysm.


METHODS
A 78-year-old man with recent stroke developed worsening exertional dyspnea and chest pain 4 years following coronary artery bypass grafting. Imaging demonstrated a bovine arch and an 8-x12-cm ascending aortic pseudoaneurysm that was compressing the pulmonary arteries. The treatment strategy was to deliver a Zenith aortic cuff to seal the ascending aortic pseudoaneurysm via a left CCA approach. With the patient under general anesthesia, the left CCA was exposed and a transverse arteriotomy was made to introduce the Zenith aortic cuff sheath; the distal CCA was clamped to prevent catheter-related embolization. With its nosecone removed, a 32-x36-mm Zenith aortic cuff was delivered to the ascending aorta via the left CCA and positioned under transient cardiac arrest initiated with intravenous adenosine. A total of 3 Zenith aortic cuffs were placed in the ascending aorta to successfully exclude the pseudoaneurysm. The patient tolerated the procedure well; follow-up imaging showed successful pseudoaneurysm exclusion without endoleak.


CONCLUSIONS
Ascending aortic pseudoaneurysm is a formidable clinical challenge due in part to the significant operative stress in a conventional surgical repair, as well as limited endovascular treatment options. Because there are no approved endovascular devices for ascending aortic aneurysm repair, clinicians may have to rely on endograft components designed for abdominal aortic aneurysms to treat lesions in the ascending aorta.
Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA. plin@bcm.edu
Peter H
PH
Lin
Panagiotis
P
Kougias
Tam T
TT
Huynh
Joseph
J
Huh
Joseph S
JS
Coselli
D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D018579:Patient Selection; D011474:Prosthesis Design; D015641:Radiography, Interventional; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome