title: Systematic review of interventions to repair ascending aortic pseudoaneurysms.
abstract: BACKGROUND
  The safety and efficacy of endovascular therapies for ascending aortic pseudoaneurysms (AAPs) are still controversial.
  
  
  METHODS
  We report an endovascular correction of an AAP in a high-risk surgical patient and present the results of a literature review focusing on AAP treatment strategies. A multilingual search of AAP therapy was performed with limiting dates of January 1980 to May 2014. The studies were classified by intervention.
  
  
  RESULTS
  A 79-year-old male with a 9 × 10 × 7 cm AAP in the anterior mediastinum was considered too high risk for surgery. An endovascular closure with a 12 mm Amplatzer septal occluder device (St. Jude Medical) was performed, and computed tomography angiography at 3-month follow-up exhibited a thrombosed AAP with minimal residual shunt. In our literature search, we identified 355 cases of AAPs, mostly case reports (91.5%) and a few patient series (8.5%). Surgical correction accounted for 73.8% of the cases, 5% of the patients were conservatively treated or considered too critically ill for any intervention, and 21.2% were treated with endovascular techniques. The most commonly reported endovascular techniques were stent grafts (9.8%) and septal occluder devices (9.8%).
  
  
  CONCLUSIONS
  Although endovascular closure of AAPs with off-label devices is a reliable option for controlling the expansion and symptoms in high-risk surgical patients, solid data on survival are lacking. Efforts to promote discussion within the heart team to expand the application of endovascular techniques can provide groundbreaking evidence to support the use of endovascular techniques as guideline therapy when facing these complicated cases.
authors.affiliation: Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Quevedo
authors.affiliation: Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Santiago-Trinidad
authors.affiliation: Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Castellanos
authors.affiliation: Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Atianzar
authors.affiliation: Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Asif
authors.initials: A
authors.lastname: Anwar
authors.affiliation: Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Nidal
authors.initials: N
authors.lastname: Abi Rafeh
keywords: Aneurysm–false; aorta; endovascular procedures; septal occluder device