From the Guidelines
An aortic arch pseudoaneurysm is a life-threatening condition that requires immediate intervention, typically through open surgical or endovascular repair, due to the high risk of fatal rupture and other complications. The implications of an aortic arch pseudoaneurysm are severe, as it can lead to rupture, fistula formation, and compression or erosion of surrounding structures if left untreated 1.
Key Considerations
- Aortic pseudoaneurysms are defined as a dilation of the aorta due to disruption of all wall layers, contained only by the periaortic connective tissue 1.
- The condition can result from various causes, including blunt thoracic trauma, iatrogenic aetiologies such as aortic surgery and catheter-based interventions, and rarely, aortic infections or penetrating ulcers 1.
- Interventional or open surgical interventions are always indicated in patients with aortic pseudoaneurysms, if feasible, regardless of size 1.
Management Approach
- The choice of treatment is based on anatomical features, clinical presentation, and comorbidities, with no randomized studies available to compare outcomes after open surgical and endovascular treatment in aortic pseudoaneurysm patients 1.
- Strict blood pressure control is crucial while awaiting surgery, using medications such as beta-blockers, ACE inhibitors, or calcium channel blockers to maintain systolic blood pressure below 120 mmHg and heart rate below 60 beats per minute.
- Close monitoring with serial imaging, such as CT angiography every 3-6 months, is necessary to assess for expansion and potential complications.
Prognosis and Risks
- Without treatment, aortic pseudoaneurysms carry a high risk of rupture, which is potentially fatal 1.
- Other life-threatening complications include fistula formation and the compression or erosion of surrounding structures, emphasizing the need for prompt and effective management.
From the Research
Implications of an Aortic Arch Pseudoaneurysm
The implications of an aortic arch pseudoaneurysm are severe and can be life-threatening due to the high risk of rupture 2. Some of the key implications include:
- High risk of rupture, which can lead to severe consequences or even death
- Difficulty in choosing the optimal treatment strategy due to anatomic features of the aortic arch 2
- Need for early follow-up imaging to monitor the pseudoaneurysm, as it may develop and rapidly expand during the first days after aortic stenting 2
- Potential for pseudoaneurysm formation after thoracic aortic stenting, which can be a complication of the procedure 2
Treatment Options
Treatment options for an aortic arch pseudoaneurysm are varied and depend on the individual patient's anatomy and pathology. Some options include:
- Endovascular coil embolization, which may be a feasible alternative in patients not considered suitable for open repair or stent-grafting 2
- Physician-modified endografts, which can be used to palliate mycotic aortic arch pseudoaneurysms in high-risk surgical patients 3
- Open surgical repair, which can be used to treat aortic arch pseudoaneurysms, especially in patients with multiple comorbidities 4
- Endovascular stent-grafting combined with chimney protection to the left common carotid artery, which can be used to repair leaking aortic-arch pseudoaneurysms 5
- Double chimney stent grafts, which can be used to treat aortic arch pseudoaneurysms between the left common carotid artery and left subclavian artery 6
Considerations for Treatment
When considering treatment options for an aortic arch pseudoaneurysm, several factors must be taken into account, including: