Ascending aortic pseudoaneurysm is a rare but serious complication after cardiothoracic surgery. While there is no established guidelines, open surgery remains the standard of care for ascending aortic repair, but caries high morbi-mortality. Recently, endovascular techniques has been used for type A dissection and ATAA, however its use remains experimental.

A 42 years-old man presented to the emergency department with acute chest pain. Thoracic computed tomography angiography (CTA) demonstrated a saccular 19x16mm pseudoaneurysm of the ascending aorta, located 10mm above the right coronary artery (Figure 1A). This was associated with perivascular infiltration (maximal diameter 68mm, Figure 1A). Importantly, the patient had undergone 4 years earlier replacement of the aortic valve, aortic root, and ascending aorta using a 26mm graft, with re-implantation of the coronary arteries into the graft (Bentall procedure) and hemiarch replacement for chronic type A dissection.

An emergency endovascular aneurysm repair using two 36x45mm Conformable GORE® EXCLUDER® AAA Aortic Extender endoprosthesis was performed. The left common carotid artery was used as the access route. Rapid pacing was employed to facilitate precise deployment of the endoprosthesis. Follow up was complicated by 2nd degree, Mobitz II AV block, that resolved spontaneously. Early post-operative CTA showed complete exclusion of the pseudoaneurysm (Figure 1B). Patient was discharged on post-operative day 4.

Endovascular repair of ascending aortic pseudoaneurysm can be lifesaving. Further investigations are warranted to define the exact benefits.