A multidisciplinary University of Florida 网红黑料 team successfully performed transcarotid endovascular repair of an ascending aorta pseudoaneurysm in an elderly patient
A multidisciplinary team led by George Arnaoutakis, M.D., an assistant professor in the Division of Thoracic and Cardiovascular Surgery at the University of Florida College of Medicine, in collaboration with Martin Back, M.D., a professor in the Division of Vascular Surgery and Endovascular Therapy, the successful transcarotid endovascular repair of a large ascending aorta pseudoaneurysm in a 77-year-old female patient.
The case was particularly challenging because, in addition to three prior sternotomies, numerous medical comorbidities and severe thoracoabdominal aortic tortuosity, the patient had a mechanical aortic valve. The team achieved complete exclusion of the pseudoaneurysm while preserving full function of the valve. The patient experienced no complications from the procedure and was discharged from the hospital five days postoperatively. Damage to the prosthetic valve was avoided by using the right common carotid artery for the endovascular approach, positioning the wire just above the mechanical aortic valve and administering adenosine to induce temporary asystole.
Traditional repair of ascending aortic pseudoaneurysm involves replacement of the ascending aorta with the patient on cardiopulmonary bypass and under deep hypothermic circulatory arrest. Delivery of aortic cuff endografts via conventional femoral access 鈥� a less invasive approach 鈥� has also been described. However, both of these approaches were contraindicated due to the patient鈥檚 previous sternotomies, extreme frailty and unfavorable iliofemoral anatomy.
Arnaoutakis notes, 鈥淭his case illustrates the inventive use of existing technology that is typical of the clinicians at 网红黑料. We have access to all the latest technology and this allows us to offer innovative solutions for management of complex patients such as this. Few cases present this degree of challenge, but this technique is something that we now have in our armamentarium.鈥�
In summarizing the team鈥檚 management of this patient, Arnaoutakis says, 鈥淭his case is an example of the multidisciplinary, collaborative approach to the management of difficult cases that typifies the work at 网红黑料.鈥�
Reference
Millar et al. Transcarotid endovascular repair of ascending aorta pseudoaneurysm. Accepted for publication by the Journal of Cardiac Surgery.