Pseudoaneurysm as a Late Complication of Hybrid Aortic Arch Repair

Hybrid aortic arch repair is increasingly used for the management of aortic arch aneurysm. Pseudoaneurysm is a newly described late complication of this procedure. A 57-year-old man underwent emergent supra-aortic debranching and aortic arch stent grafting after rupture of an arch aneurysm. Three years later, the patient presented with a pseudoaneurysm at the junction between the stent graft's proximal landing zone and the origin of the debranching graft. At reoperative repair, the proximal stent graft had eroded through the aortic wall at the junction of the endograft proximal landing zone and the proximal anastomosis of the debranching graft. The presence of a dilated, fragile ascending aorta at the initial procedure seemed to be a risk factor for development of the pseudoaneurysm. Replacement of the ascending aorta combined with supra-aortic debranching has become an accepted strategy in hybrid arch repair to establish a suitable landing zone for the endograft.