Transcatheter closure of a posterior ascending aortic pseudoaneurysm after aortic dissection repair: a case report

Ascending aortic pseudoaneurysm is a rare but potentially fatal complication after aortic surgery, particularly challenging in elderly high-risk patients.

We report an 80-year-old man with a history of surgical repair for acute type A aortic dissection who presented with a two-month history of chest pain. Transthoracic echocardiography and computed tomography angiography revealed a large posterior ascending aortic pseudoaneurysm measuring 6.5 × 5.4 cm with a narrow neck. Because of his advanced age, previous sternotomy, and overall frailty, the patient was considered unsuitable for redo surgery after heart team discussion.

After obtaining written informed consent, the patient underwent successful percutaneous closure using a 10-mm Cocoon Septal Occluder device via transfemoral access. The procedure was uncomplicated, and immediate angiography confirmed minimal residual flow. Six-month follow-up computed tomography angiography demonstrated complete thrombosis of the aneurysm sac, and the patient remained asymptomatic with no residual shunt at two-year follow-up.

This case illustrates that transcatheter closure of a posterior ascending aortic pseudoaneurysm using a septal occluder device can be a safe and durable alternative to high-risk reoperation, provided that careful pre-procedural imaging and catheter selection are performed.