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Objective: Pseudoaneurysms are a well-described late complication of thoracoabdominal aortic aneurysm repair. Patients with connective tissue disorders, such as Marfan syndrome, are among those at highest risk for this problem. Open surgical repair of pseudoaneurysms carries substantial morbidity in these patients. The purpose of this report is to describe our initial experience using an endovascular approach to treat thoracic aortic pseudoaneurysms in Marfan patients.
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Joseph S. Coselli, Karen Amerman, Charlie Cheng, Scott A. LeMaire.
Division of Cardiothoracic Surgery, Baylor College of Medicine and the Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX, USA.
Methods: Three patients with Marfan syndrome who had previously undergone thoracoabdominal aortic aneurysm repair presented with pseudoaneurysms involving the descending thoracic portion of their grafts. The pseudoaneurysms involved intercostal reattachment sites in two patients and a graft-to-graft anastomosis in one. One pseudoaneurysm had ruptured. In each case, stent grafts were deployed within the existing aortic graft to achieve endoluminal coverage of the pseudoaneurysm.
Results: Endoluminal pseudoaneurysm exclusion was successful in all three patients, each of whom recovered without paraplegia or other complications. The intervals between the procedures and discharge home were one and two days for the two patients with unruptured pseudoaneurysms, and six days for the patient with a ruptured pseudoaneurysm. All three patients are alive and without complications at current follow-up (13 to 58 months after the procedure); each patient has had a recent computed tomography scan (13 to 53 months) confirming continued aneurysm exclusion without evidence of stent migration or endoleak.
Conclusions: The appropriateness of using endovascular aortic stent grafts in patients with Marfan syndrome is controversial; however, endografts may be well-suited for excluding focal pseudoaneurysms occurring at anastomotic sites in these patients, provided that the existing aortic graft can be used for the proximal and distal landing zones.
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