Descending Thoracic Aorta Pseudoaneurysm

Author: John Hermsen, MD; Michael Mulligan, MD; Edward Verrier, MD
Institution: University of Washington
Date Reviewed: August 2014
Learning Domain: Adult Cardiac Surgery
Learning Objective: Aorto-pulmonary Fistula; Descending Thoracic Aortic Pseudoaneurysm
PowerPoint File: Descending Thoracic Aorta Pseudoaneurysm

Discussion Points for Conference

• Acute Control of Potential Catastrophic hemoptysis
• Pathophysiology of Aorto-bronchial fistula
• Role of Endovascular  stenting
  • Definitive vs Bridge
• Role of Surgical Management
  • Anesthetic support / monitoring
  • Spinal Cord Protection
  • Perfusion strategies
• Aortic reconstruction with Infection

Principles of Endovascular Control of Fistula

• Good anesthetic management team
• Balloon dilation of previous coarctation stent graft if necessary
• Occlusion of Previous Bypass graft
• Coverage of pseudo-aneurysm  leak site with TEVAR
  • Leave left subclavian artery uncovered if possible
  • Carotid to subclavian bypass if necessary to cover

Learning Points

• Aorto-bronchial fistula associated with descending aortic pathology
• Natural history is lethal
• Any graft material is infected by definition
• Complicated decision making
• Endovascular  grafting very helpful adjunct or bridge to definitive surgery