Endovascular stent-grafting of anastomotic pseudoaneurysms following thoracic aortic surgery

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.

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.

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.

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.