Clinical Image

Prosthetic Graft Occlusion Caused by Anastomotic Pseudoaneurysm

Shuhei Miura*, Yutaka Iba, Yoshihiko Kurimoto, Kosuke Ujihira, Ryushi Maruyama, Eiichiro Hatta, Akira Yamada and Katsuhiko Nakanishi
Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Japan


*Corresponding author: Shuhei Miura, Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Teineku, Sapporo, Hokkaido 006-8555, Japan


Published: 02 Nov, 2017
Cite this article as: Miura S, Iba Y, Kurimoto Y, Ujihira K, Maruyama R, Hatta E, et al. Prosthetic Graft Occlusion Caused by Anastomotic Pseudoaneurysm. Clin Surg. 2017; 2: 1712.

Clinical Image

A 61-year-old man who had undergone total arch replacement with frozen elephant trunk (FET) for acute type A aortic dissection (Figure 1A: 3D-image) was transferred complaining of severe abdominal and leg pain. The patient’s pulsation of carotid artery and radial artery could be identified but that of bilateral femoral arteries could not. Computed tomography (CT) showed large hematoma and pseudoaneurysm formation around the proximal anastomotic site suppressing prosthetic arch graft, which was complicated with almost complete occlusion of thoracic descending aorta below FET (Figure 1B: 3D-image at hospital arrival, C-D: Axial slice). As it led to the compromised hemodynamics with a high lactate value of 98 mg/dl, the patient was transferred to the hybrid OR for emergency thoracic endovascular aortic repair (TEVAR) to release the prosthetic graft occlusion and recover the lower body perfusion. The procedure to advance guidewire through the thrombotic occluded graft was difficult, Relay Plus 30 mm × 15 cm endograft (Bolton Medical, Barcelona, Spain) was implanted to preserve the left subclavian artery (LSA) with overlapped FET. Although balloon was touched up many times following 32-mm proximal aortic cuff with Zenith TX2 endograft (Cook Medical Incorporated, Bloomington, IN, USA) was deployed,the expansion of the tip of the stent was inadequate due to hematoma suppression, which could not recover adequate antegrade blood perfusion (Figure 2: Angiography image). At this stage, the hemodynamics deteriorated to shock conditions with scattered pupils, and he died in a few hours after operation. Hematoma suppression related with anastomotic pseudoaneurysm caused thrombotic occlusion of the thoracic descending aorta from FET, which had resulted in lower body organs ischemia. Emergency surgical strategy for life-saving was controversial. Cardiopulmonary bypass or extracorporeal membrane oxygenation using retrograde arterial perfusion from femoral artery was not adapted because of the high risk of thrombotic cerebral infarction. Therefore, prior to the surgical repair for anastomotic pseudoaneurysm, TEVAR was performed as soon as possible to improve antegrade arterial perfusion.

Figure 1

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Figure 1
a) 3D-image, b) 3D-image at hospital arrival, and C,D) Axial slice.

Figure 2

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Figure 2
Angiography image.