Fogarty balloon occlusion of ruptured abdominal aorticaneurysm was first described by heinbecker in 1964(1). The incidenceof pseudoaneurysm post bentall procedure is around 8 to 10 %. Pseudoaneurysm can occur in earlyor late post operative period. Symptoms of pseudoaneurysm post bentall procedure includepulsatile suprasternal mass, chest pain, pressure symptoms such as dyspnea,dysphagia, svc obstruction resulting in oedema of head neck and arms. Sepsismay occur if the pseudoaneurysm is due to infective etiology.
Site of occurrence of pseudoaneurysm in vascularreconstruction may be at the anastamotic or non anastamotic site. Causes ofanastamotic pseudoaneurysm can be suture dehiscence or infection. Nonanastamotic pseudoaneurysm can occur because of intrinsic graft fiberdegeneration (2) or extrinsic mechanical stress. Around five casesof non anastamotic pseudoaneurysm of Dacron prostheses by direct damage hasbeen reported. The etiology of these cases range from erosion of graft causedby calcified aorta (3), rib (4,5) or strut of biobentallprosthesis. In our case the probable pathology could be iatrogenic injuryduring needle aspiration or the bony spur in sternum causing external injury. In particular, Gelweave woven Dacron prostheses have a thin wall,which may be related to the rupture.
To avoid such complications, the graftshould be positioned away from the bony surfaces or aortic calcification.Withregard to the treatment for such a rare complication, endovascular repairs arequicker and easier. Open repairs need some time for body positioning, resternotomy and cardiopulmonary bypass, although they are more durable thanendovascular repairs. Ballon occlusion is being used in endo cardiopulmonarybypass as an alternative to aortic cross clamping . Its use has also been reported for 1.
Successful occlusion of theorifice of the pseudoaneurysm (6) 2. Occlude the distal aortaduring prosthetic replacement of an aortic arch aneurysm under conditions ofseparate cerebral and peripheral perfusion3. Stab wound to the heart -sternotomy & balloon occlusion 4.
Aortic occlusion to arresthemorrhage in ruptured abdominal aortic aneurysm (7) Consequently, we employed direct closure of the graftinjury by taking proximal control using fogarty, passed retrograde fromarteriotomy near distal anastomosis.