2007 Abstracts: Use of the Percutaneous Septal Occluder To Exclude An Aortic Pseudoaneurysm

Background: Aortic pseudoaneurysm is a seriouis condition, which if untreated, is likely to lead to rupture and death. Historically, open reapir has been the standard treatment when these pseudoaneurysms are enlarging and felt to be at increased risk of rupture. Endovascular repair or coil embolization has been used with limited success, but the applicability of this technology is dependent on favorable anatomy. Endovascular placement of septal occlusion devices has been used as an increasingly acceptable method for occlusion of blood flow through an atrial septal defect (ASD) or ventricular septal defect (VSD). The Amplatzer Septal Occluder(AGA Medical Corporation, Golden Valley, MN) is a double-disc device consisting of two Dacron discs in a dumbbell shaped cage of nitinol, deployed attached to a removeable wire through a 6 or 8 French guide sheath. We describe a case of an aortic pseudoaneurysm, assumed to have resulted from clamp trauma, adjacent to an occluded left renal artery, which was successfully occluded by endovascular placement of the Amplatzer Septal Occluder.
Case: A 78 year old male underwent successful aorto-bifemoral bypass grafting in the remote past for an AAA. He subsequently occluded his left renal artery with the loss of the left kidney. Follow-up CT scan demonstrated a pseudoaneurysm adjacent to the occluded left renal artery, proximal to the aortic anastamosis. Attempts at coil embolization failed to obliterate the pseudoaneurysm. Because of his coronary artery disease, he was not felt to be a candidate for open repair, and the pseudoaneurysm was initially followed closely, rather than repaired open. Follow-up over three years showed progressive inlargement from 37mm by 29mm to 49mm by 36 mm. He was felt to be at increased risk for rupture of the pseudoaneurysm but was not felt to be a candidate for open repair due to his multiple medical comorbidities. He underwent successful occlusion of the false aneurysm by endovascular placement of the Amplatzer Septal Occluder across the opening into the psuedoaneurysm. Completion angiogram showed markedly diminished flow within the pseudoaneurysm.
Results: A follow-up CT scan one month post-procedure showed no further increase in size of the false aneurysm and apparent exclusion of the pseudoaneurysm. The patient was in stable condition without complications from the procedure.
Conclusions: Endovascular exclusion of pseudoaneurysms of the abdominal aorta is a reasonable alternative to open repair in pateients with prohibitive operative risks. When coiling is not successful, endovascular placement of an atrial septal occlusion device is another alternative. To our knowledge, this is the first reported case of the use of the Amplatzer Septal Occluder to exclude an aortic pseudoaneurysm.