A Comparison of Percutaneous and Endovascular Techniques for Treating Ascending Aortic Pseudoaneurysms

Purpose: Nonsurgical techniques can be used for the treatment of ascending aortic pseudoaneurysms (AAPs) as an alternative to open surgical repair, which has a high risk of perioperative morbidity and mortality. We seek to evaluate the differences in outcomes between two of these nonsurgical techniques in the management of patients with AAPs.

Materials and Methods: A single-center retrospective review was done of nonsurgical procedures performed for the treatment of AAPs between December 2015 and October 2018. All patients treated with an endovascular or computed tomography and/or fluoroscopic guided transthoracic percutaneous approach were included. Occlusion methods included modified aortic stent grafts and atrial or ventricular septal defect occlusion devices for endovascular treatment and coil and liquid embolics for percutaneous treatment. Pre- and postcontrast-enhanced imaging studies were obtained in all patients.

Results: A total of 10 patients underwent 14 procedures. The mean follow-up time after treatment was 212 ± 261days (range, 3–795 days). Five patients were initially treated via a transthoracic approach with 3 reinterventions for a total of 8 cases, and 5 patients were treated via an endovascular approach with 1 reintervention for a total of 6 cases. Four of the percutaneously treated AAPs had residual perfusion at the end of the case or on follow-up imaging. One patient treated with endovascular approach had residual perfusion at the end of the case. Of the 4 patients who underwent a second intervention, only 1 (endovascular approach) showed persistent filling on follow-up examination. The mean time to discharge after a percutaneous treatment was 2.1 ± 1.3 days. The mean time to discharge after an endovascular treatment was 5.8 days ± 3.1 days. The mean AAP size treated with a percutaneous approach was 4.8 ± 0.4 cm ´ 2.8 ± 0.5 cm, and the mean size treated via an endovascular approach was 5.3 ± 3.1 cm ´ 3.6 ± 2.2 cm. There was one death attributed to the treatment in an endovascular approach case and none from percutaneous treatment.

Conclusions: Nonsurgical methods are an effective treatment for AAPs. Candidates for treatment via a transthoracic percutaneous approach can be counseled that there may be a higher chance of requiring a reintervention than those treated via an endovascular approach, but it is still relatively safe and effective.