Endovascular treatment of a descending thoracic pseudoaneurysm involving an intercostal loop graft

A 43 year-old man with past history of an extent I thoracoabdominal aortic aneurysm (TAAA) repair presented with an enlarging pseudoaneurysm involving an intercostal limb of a branched descending thoracic aortic graft. Right brachial artery and right common femoral artery were used to access the proximal and distal portions of the intercostal limb graft respectively, and a snare was used to establish access across the entire length of the tortuous graft. Under somatosensory evoked potential monitoring (SSEP), angioplasty balloons were used to occlude the distal and proximal ends of the limb graft. After observing no change in signals, two 16mm Amplatzer vascular plugs were used to occlude the distal and proximal portions of the intercostal limb graft thereby excluding the source of the enlarging pseudoaneurysm and redirecting flow through the main descending thoracic aortic graft. This case demonstrates that endovascular options should be considered in patients presenting with late complications such as pseudoaneurysms after previous open thoracic aortic surgery.