Case Reports Percutaneous Treatment of Late-Aortic Pseudoaneurysm Resulting From Surgical Repair of Aortic Coarctation Mohammad Shakil Aslam, MD, Babak Haddadian, MD, and Tanvir Bajwa, * MD We describe the case of a 38-year-old woman who presented with symptoms of chest pain and shortness of breath that had worsened over the previous 6 months and was found to have a large pseudoaneurysm (PSA) of the thoracic aorta. She underwent sur- gical repair of aortic coarctation at the age of 16 and a revision of her bypass graft at age 28 when she presented with hemoptysis due to aortic PSA and aortobronchial fis- tula. Our cardiothoracic surgical team deemed a third surgery very high risk; therefore, she was referred to us for percutaneous repair of aortic PSA. We describe the suc- cessful treatment of the PSA using a technique of microcoil embolization and Amplatzer V R vascular plug (AGA Medical Corp., Plymouth, MN). V C 2011 Wiley-Liss, Inc. Key words: aortic pseudoaneurysm; aortic coarctation; percutaneous treatment; Amplatzer vascular plug; coil embolization CASE REPORT A 38-year-old woman presented to our institution with shortness of breath and chest pain. Her symptoms started about 6 months prior and had been getting worse. Chest pain occurred mostly at rest and involved sharp sensation that occasionally spread to the back. Shortness of breath was usually associated with exer- tion, though it sometimes occurred at rest, but was not accompanied by orthopnea or paroxysmal nocturnal dyspnea. She had no leg swelling, cough, fever or chills. The patient had recently been diagnosed with hyper- tension and had a history of aortic coarctation, which was repaired at the age of 16 with aortic bypass graft. That surgical report was not available to us. Appa- rently, she had resection of the native thoracic aorta and oversewing of the proximal (cephalic) and distal (caudal) ends. Bypass graft was placed end-to-side both proximally and distally. She presented with hemoptysis at age 28. Upper endoscopy and bronchos- copy were negative. Further work-up with a computer- ized axial tomography (CAT) scan indicated a large pseudoaneurysm (PSA) from the cephalic end of the aorta. The patient underwent open surgical repair. During surgery, it was noted that she had a PSA origi- nating from the cephalic end of the aorta and an aorto- parenchymal fistula, causing her hemoptysis. The aortoparenchymal fistula was repaired by wedge resec- tion, and her previous graft was totally excised due to the possibility of infectious etiology (although the sur- gical pathology result was not available at that time). A new proximal end-to-side Dacron graft was attached to the aorta distal to the left subclavian artery and a distal end-to-side anastomosis to the aorta above the renal arteries. Both the cephalic and caudal ends of de- scending thoracic aorta were sutured, oversewn and repaired. The patient recovered and did well until recently, when she presented to the cardiothoracic sur- gical team with chest pain and shortness of breath. Six months before presenting, a CAT scan of the patient’s chest and abdomen indicated an aortic PSA Aurora Cardiovascular Services, Aurora Sinai/Aurora St Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin Conflict of interest: Nothing to report. *Correspondence to: Tanvir Bajwa, MD, 2801 W. Kinnickinnic River Parkway #777, Milwaukee, WI 53215, USA. E-mail: publishing2@aurora.org Received 14 November 2010; Revision accepted 22 November 2010 DOI 10.1002/ccd.22910 Published online 17 March 2011 in Wiley Online Library (wileyonlinelibrary.com) V C 2011 Wiley-Liss, Inc. Catheterization and Cardiovascular Interventions 78:619–624 (2011)