Endovascular stent-graft repair of anastomotic pseudoaneurysms after aortic arch replacement: A case series of 3 patients.

Pseudoaneurysm formation after total aortic arch replacement (TAR) with a frozen elephant trunk (FET) is a rare complication; however, we have experienced 3 cases who developed pseudoaneurysms at graft-to-graft anastomoses in the remote postoperative period. In all 3 cases, the pseudoaneurysms formed several years after FET-assisted TAR at sites adjacent to the sternum, specifically at the anastomoses between the prosthetic graft branches and the left axillary artery (LAxA) bypass graft. Pseudoaneurysms usually occur at anastomoses between native vessels and prosthetic grafts; however, a distinctive feature of these cases is that they all developed pseudoaneurysms at the graft-to-graft anastomoses, an extremely rare location. Because surgical reconstruction by re-sternotomy was considered highly invasive, all 3 cases underwent stent-graft endovascular treatment (EVT). Complete exclusion of the pseudoaneurysms was achieved in all 3 cases, and no re-expansion or rebleeding was observed during their follow-up. This report presents 3 rare cases in which EVT was effective for repairing pseudoaneurysms occurring at prosthetic graft anastomoses, an extremely rare location, in the remote postoperative period after FET-assisted TAR.