A multidisciplinary University of Florida Health team successfully performed transcarotid endovascular repair of an ascending aorta pseudoaneurysm in an elderly patient

A multidisciplinary team led by George Arnaoutakis, M.D., an assistant professor in the Division of Thoracic and Cardiovascular Surgery at the University of Florida College of Medicine, in collaboration with Martin Back, M.D., a professor in the Division of Vascular Surgery and Endovascular Therapy, recently reported the successful transcarotid endovascular repair of a large ascending aorta pseudoaneurysm in a 77-year-old female patient.

The case was particularly challenging because, in addition to three prior sternotomies, numerous medical comorbidities and severe thoracoabdominal aortic tortuosity, the patient had a mechanical aortic valve. The team achieved complete exclusion of the pseudoaneurysm while preserving full function of the valve. The patient experienced no complications from the procedure and was discharged from the hospital five days postoperatively. Damage to the prosthetic valve was avoided by using the right common carotid artery for the endovascular approach, positioning the wire just above the mechanical aortic valve and administering adenosine to induce temporary asystole.

Traditional repair of ascending aortic pseudoaneurysm involves replacement of the ascending aorta with the patient on cardiopulmonary bypass and under deep hypothermic circulatory arrest. Delivery of aortic cuff endografts via conventional femoral access — a less invasive approach — has also been described. However, both of these approaches were contraindicated due to the patient’s previous sternotomies, extreme frailty and unfavorable iliofemoral anatomy.

Arnaoutakis notes, “This case illustrates the inventive use of existing technology that is typical of the clinicians at UF Health. We have access to all the latest technology and this allows us to offer innovative solutions for management of complex patients such as this. Few cases present this degree of challenge, but this technique is something that we now have in our armamentarium.”

In summarizing the team’s management of this patient, Arnaoutakis says, “This case is an example of the multidisciplinary, collaborative approach to the management of difficult cases that typifies the work at UF Health.”

Reference

Millar et al. Transcarotid endovascular repair of ascending aorta pseudoaneurysm. Accepted for publication by the Journal of Cardiac Surgery.