Stent Grafting for an Ascending Aorta Pseudoaneurysm in an 86-Year-Old

By Eric E. Roselli, MD

An 86-year-old man who was living independently presented in early 2016 with a large pseudoaneurysm on the ascending aorta (Figure 1) in close proximity to widely patent grafts from a previous coronary artery bypass procedure.

Figure 1. CT of the pseudoaneurysm on presentation.

Further inspection on CT scan showed the pseudoaneurysm to be immediately adjacent to the back of the sternum (Figure 2), further complicating management of this highly functional but still quite elderly patient.

Figure 2. Preoperative CT showing proximity of the pseudoaneurysm to the sternum.

After weighing options, the surgical team in Cleveland Clinic’s Aorta Center devised a plan to address the pseudoaneurysm by placing a stent graft (Figure 3) delivered through the right axillary artery.

Figure 3. CT showing the implanted stent graft.

After extubation the next morning, the patient was back on his feet and out of the ICU within two days. He continues to fare well.

Cleveland Clinic’s ability to develop inventive endovascular strategies like this stems from its unmatched aortic surgery volumes, which consistently approach or exceed 1,200 annually (N = 1,185 in 2015). Its mortality rates for thoracic aorta surgery procedures consistently outperform expected rates (e.g., 2015 observed/expected ratio of 0.8) despite an abundance of complex cases like the one profiled here.

For more outcomes and volume information from Cleveland Clinic’s Miller Family Heart & Vascular Institute, visit clevelandclinic.org/outcomes.

Dr. Roselli is a cardiothoracic surgeon and Director of Cleveland Clinic’s Aorta Center.