PMC5576010_01
Pre-operative contrast-enhanced CT scan of the ascending aortic pseudoaneurysm.
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He was subsequently admitted with chest pain, a CT scan revealed a large dilatation of the distal ascending aortic arch consistent with a pseudoaneurysm from a previous anastomosis (Fig. 1).
3D reconstruction of contrast-enhanced CT illustrating the relationship of the ascending aortic aneurysm to the great vessels and coronary ostia.
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The relationship of the pseudoaneurysm to the great vessels and coronary ostia is illustrated in Fig. 2.
Angiogram demonstrating unique "reverse" debranching of the aortic arch with left subclavian artery to left carotid artery bypass, and left to right carotid to carotid bypass. There is retrograde flow in the innominate artery.
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A "reverse" arch debranching procedure was performed comprising: 1) left subclavian artery to left carotid artery bypass; 2) left to right carotid to carotid bypass; and 3) left common carotid artery ligation (Fig. 3).
Contrast-enhanced CT illustrating fluid around the left limb of the previous aortobifemoral graft.
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Higher femoral cut-down either by groin incision or retroperitoneal incision was considered, however, there was concern about infection of the fluid collections surrounding the aortobifemoral graft (Fig. 4).
Intra-operative angiogram illustrating embolization coils in pseudoaneurysm and endoleak tract.
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Type 1a endoleak. This was embolized with multiple coils in the pseudoaneurysm and in the endoleak tract (Fig. 5).
Contrast-enhanced CT scans performed pre- and post-embolization of the pseudoaneurysm sac, demonstrating reduction in aneurysm size to 5.1 cm and no endoleak.
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Follow-up CT scan has shown a reduction in the size of the pseudoaneurysm and no endoleak (Fig. 6).