Transcatheter closure of a posterior ascending aortic pseudoaneurysm after aortic dissection repair: a case report

Background: Ascending aortic pseudoaneurysm is a rare but potentially fatal complication after aortic surgery, particularly challenging in elderly high-risk patients. Case presentation: We report an 80-year-old man with a history of surgical repair for acute type A aortic dissection who presented with a two-month history of chest pain. Transthoracic echocardiography and computed tomography angiography revealed a large posterior ascending aortic pseudoaneurysm measuring 6.5 × 5.4 cm with a narrow neck. Because of his advanced age, previous sternotomy, and overall frailty, the patient was considered unsuitable for redo surgery after heart team discussion. Management and outcome: After obtaining written informed consent, the patient underwent successful percutaneous closure using a 10-mm Cocoon Septal Occluder device via transfemoral access. The procedure was uncomplicated, and immediate angiography confirmed minimal residual flow. Six-month follow-up computed tomography angiography demonstrated complete thrombosis of the aneurysm sac, and the patient remained asymptomatic with no residual shunt at two-year follow-up. Conclusion: This case illustrates that transcatheter closure of a posterior ascending aortic pseudoaneurysm using a septal occluder device can be a safe and durable alternative to high-risk reoperation, provided that careful pre-procedural imaging and catheter selection are performed.