Endovascular Solution for Anastomotic Pseudoaneurysm of the Ascending Aorta.
7 affiliations
- 1Vascular and Endovascular Surgery Unit, Sandro Pertini Hospital, Rome, Italy.
- 2Cardiovascular Surgery Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
- 3Vascular and Endovascular Surgery Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy. Electronic address: [email protected].
- 4Vascular and Endovascular Surgery Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
- 5Division of Cardiology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
- 6Interventional Radiology Unit, Hospital Sant'Andrea, Sapienza University of Rome, Rome, Italy.
- 7Department of General and Specialistic Surgery, and Anaesthesiology, University of Rome La Sapienza, Rome, Italy.
Abstract
Objective
The objective was to demonstrate the feasibility of ascending thoracic endovascular aortic repair (a-TEVAR) as a minimally invasive treatment for an ascending anastomotic pseudoaneurysm in a patient unsuitable for redo open surgery.Key steps
The steps included: 1) multidisciplinary evaluation and detailed computed tomography angiography-based anatomical planning; 2) assessment of proximal and distal landing zones, coronary ostia, and supra-aortic vessel anatomy; 3) selection of a Gore C-TAG endograft based on anatomical suitability; 4) percutaneous transfemoral a-TEVAR under rapid ventricular pacing with intraoperative angiographic guidance; and 5) confirmation of complete pseudoaneurysm exclusion while preserving coronary and supra-aortic vessel patency, followed by serial computed tomography angiography surveillance.Potential pitfalls
Limited landing zones, proximity to the coronary ostia and supra-aortic vessels, inaccurate device deployment, and the absence of dedicated ascending aortic devices increase procedural complexity. Careful patient selection, meticulous preoperative planning, and rapid ventricular pacing are essential to minimize these risks.Take-home messages
The a-TEVAR procedure is a feasible alternative to high-risk redo sternotomy in carefully selected patients with favorable anatomy. However, a-TEVAR of the ascending aorta continues to pose significant technical and clinical challenges, and further investigations are needed.
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BibTeX
@article{margheritini2026endovascular,
title = {{Endovascular Solution for Anastomotic Pseudoaneurysm of the Ascending Aorta.}},
author = {C Margheritini and M Coli and G Colonna and C Battocchio and F Capuano and A Berni and M Rossi and L Rizzo and G Melina and P Sirignano},
journal = {JACC. Case reports},
year = {2026},
month = oct,
doi = {10.1016/j.jaccas.2026.110218},
url = {https://europepmc.org/article/MED/42847576},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Endovascular Solution for Anastomotic Pseudoaneurysm of the Ascending Aorta.
AU - C Margheritini
AU - M Coli
AU - G Colonna
AU - C Battocchio
AU - F Capuano
AU - A Berni
AU - M Rossi
AU - L Rizzo
AU - G Melina
AU - P Sirignano
PY - 2026
DA - 2026/10/01
JO - JACC. Case reports
DO - 10.1016/j.jaccas.2026.110218
UR - https://europepmc.org/article/MED/42847576
AB - Objective The objective was to demonstrate the feasibility of ascending thoracic endovascular aortic repair (a-TEVAR) as a minimally invasive treatment for an ascending anastomotic pseudoaneurysm in a patient unsuitable for redo open surgery.Key steps The steps included: 1) multidisciplinary evaluation and detailed computed tomography angiography-based anatomical planning; 2) assessment of proximal and distal landing zones, coronary ostia, and supra-aortic vessel anatomy; 3) selection of a Gore C-TAG endograft based on anatomical suitability; 4) percutaneous transfemoral a-TEVAR under rapid ventricular pacing with intraoperative angiographic guidance; and 5) confirmation of complete pseudoaneurysm exclusion while preserving coronary and supra-aortic vessel patency, followed by serial computed tomography angiography surveillance.Potential pitfalls Limited landing zones, proximity to the coronary ostia and supra-aortic vessels, inaccurate device deployment, and the absence of dedicated ascending aortic devices increase procedural complexity. Careful patient selection, meticulous preoperative planning, and rapid ventricular pacing are essential to minimize these risks.Take-home messages The a-TEVAR procedure is a feasible alternative to high-risk redo sternotomy in carefully selected patients with favorable anatomy. However, a-TEVAR of the ascending aorta continues to pose significant technical and clinical challenges, and further investigations are needed.
SN - 2666-0849
ER -