✍ Scribed by Neeraj Jolly; Ravi Kumar Garg; Jaishankar Raman; Ziyad M. Hijazi
No coin nor oath required. For personal study only.
We read with interest the report by Kanani et al. [1] describing the use of Amplatzer 1 1 septal occluder device in percutaneous management of pseudoaneurysms involving the thoracic aorta. We agree with their assessment that long-term follow-up is necessary to establish the efficacy of this treatment, and would like to share our experience of a similar case where the longterm result was unsatisfactory despite an apparently early success with this device.
A 96-year-old man received a 28-mm Amplatzer septal occluder in early 2005 for a pseudoaneurysm involving the descending thoracic aorta (Fig. 1A). The aneurysm measured 36 mm in its largest diameter and its neck measured 24-26 mm in diameter. Deployment of the 28-mm device using a no. 11-French Hausdorf sheath was uncomplicated and the excellent device position and immediate partial obliteration of the pseudoaneurysm confirmed on angiography and by computerized tomography (Fig. 1B). A repeat CT scan 2 months later, however, revealed an increase in the size of the aneurysm. Percutaneous treatment with a stent graft was offered but declined by the elderly patient. He presented in November 2006 with abdominal pain and a repeat CT scan demonstrated a significant increase in the size of the aneurysm that now measured 8 3 11 3 8 cm in size. The occluder device had migrated posteriorly to the paraspinal region (Fig. 1C,D).
Use of an Amplatzer septal occluder device for treatment of a pseudoaneurysm of the thoracic aorta did not impart a long term benefit in this patient. It is conceivable that in the setting of pathologies such as pseudoaneurysm of the aorta a firm rim of tissue is not available for a stable device position. This may result in device migration.
📜 SIMILAR VOLUMES
We report the first case of the use of an Amplatzer septal occluder device to close a large ascending aortic pseudoaneurysm. The patient had a complex cardiac history with redo coronary artery bypass graft surgery, severe left ventricular dysfunction, and end-stage renal disease requiring hemodialys