Intercostal bypass graft pseudoaneurysm repaired with percutaneous glue embolization utilizing CT needle guidance: A case report.

Abstract

Objectives: Pseudoaneurysm formation in connective tissue patients postoperatively can be a challenging and life-threatening problem to treat. Repair of an aorta to intercostal bypass graft pseudoaneurysm post open thoracoabdominal aortic aneurysm repair by percutaneous glue embolization utilizing Dyna CT Needle Guidance technology is a safe, minimally invasive method with low morbidity and short post-procedural recovery.

Methods: A 30-year-old male with suspected connective tissue disorder who developed a Type B aortic dissection complicated by limb threatening right lower extremity ischemia treated with left-to-right fem-fem bypass and RLE fasciotomies. His thoracic aortic dissection subsequently was repaired urgently for persistent chest pain and rapid aortic expansion by open thoracoabdominal aortic aneurysm repair with aorta to intercostal bypass graft. Seven weeks postop patient presented with hemoptysis and was noted to have an enlarging T9 intercostal pseudoaneurysm requiring repair.

Results and conclusions: Post discharge follow-up thoracic CTA performed showed complete resolution of the T9 intercostal pseudoaneurysm. Therefore, percutaneous NBCA glue embolization with iGuide technology is a viable alternative to open thoracic pseudoaneurysm repair and offers distinct advantages over other imaging modalities for localization.