Author + information
- Received February 24, 2013
- Accepted March 15, 2013
- Published online October 1, 2013.
- Satya S. Shreenivas, MD∗∗ (, )
- Scott Lilly, MD∗,
- Nimesh D. Desai, MD†,
- Ali Farooki, MD‡,
- Albert T. Cheung, MD‡,
- Michael A. Acker, MD†,
- Howard C. Herrmann, MD∗ and
- Saif Anwaruddin, MD∗
- ∗Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- †Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- ‡Department of Anesthesia and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- ↵∗Reprint requests and correspondence:
Dr. Satya Shreenivas, Hospital of the University of Pennsylvania, 8 Gates Pavilion, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
- amplatzer vascular plug
- aortic pseudoaneurysm
- coronary artery bypass complication
- saphenous vein graft dehiscence
An 80-year-old woman with a past medical history significant for coronary artery bypass surgery (7 months prior) complicated by cardiac arrest 3 days post-surgery was found to have saphenous vein graft dehiscence from the aortic anastomosis, mediastinal bleeding, and a large hemothorax. She was then re-admitted for a bleeding chest wound. A computed tomography (CT) scan of the chest revealed a saccular pseudoaneurysm arising from the anterior wall of the ascending aorta close to the anastomosis of the previously dehisced saphenous vein graft. There was concern for ongoing extravasation from this site and impending rupture (Figs. 1 and 2, Online Videos 1 and 2⇓⇓).
Due to multiple comorbidities, advanced age, and prior sternotomies, she was deemed high risk for open repair. Other alternatives were considered, including a covered stent in the ascending aorta or percutaneous closure of the pseudoaneurysm with a vascular plug. Due to the more invasive nature of an aortic stent graft, she was referred for urgent percutaneous closure of the pseudoaneurysm with a vascular plug (Figs. 3 to 5⇓⇓⇓, Online Videos 3, 4, and 5).
Multimodality imaging including fluoroscopy, CT scan, and transesophageal echocardiography were key in locating, sizing, and successful closure of the pseudoaneurysm with an 8-mm Amplatzer Vascular Plug II (AGA Medical Corporation, Plymouth, Minnesota).
Dr. Herrmann is a consultant for St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 24, 2013.
- Accepted March 15, 2013.
- American College of Cardiology Foundation