Transcatheter coil embolization for proximal thoracic aortic pseudoaneurysms: a case series with mid-term clinical and imaging follow-up

OBJECTIVES: Proximal aortic pseudoaneurysms represent a life-threatening complication of cardiac surgery. Traditional redo surgery is associated with substantial operative risk, while conventional endovascular stenting is often precluded by complex anatomy. We evaluated the clinical feasibility, safety, and durability of transcatheter coil embolization for proximal aortic pseudoaneurysms in a high-risk cohort. METHODS: Between September 2020 and February 2024, nine consecutive high-risk patients with proximal aortic pseudoaneurysms underwent transcatheter coil embolization at our institution. Preoperative risk profiles, procedural characteristics, intra-hospital outcomes, and serial computed tomography angiography follow-up datasets were retrospectively analyzed. RESULTS: The cohort was predominantly male (88.9%), with a mean age of 69.1±13 years and a mean Logistic EuroSCORE of 22.82%±18.76%. Patients had undergone a mean of 2.56 previous aortic procedures. Access routes included transfemoral (n = 6), transapical (n = 3), axillary (n = 1), and transbrachial (n = 1) approaches. Stent-assisted embolization was deployed in two cases. Technical success was achieved in all cases, with a median post-procedural stay of six days. Mean follow-up was 16±14.8 months. Serial imaging demonstrated stable sac dimensions in all patients, with no local recurrences. All-cause mortality was 33.3% (n = 3), and all deaths were attributed to sudden systemic events unrelated to target lesion failure or rupture. CONCLUSIONS: Transcatheter coil embolization appears to be a safe, technically feasible, and durable alternative for the exclusion of proximal aortic pseudoaneurysms. In this small high-risk cohort, the technique achieved excellent local control and mid-term structural stability in fragile, multi-operated patients who were not candidates for conventional open surgery.