Abstract 12462: Percutaneous Repair of Chronic Aortic Pseudoaneurysm: A Single Center Experience

Introduction: Aortic pseudoaneurysm (AP) is a late complication of aortic repair. Without intervention, it carries a mortality rate up to 61%. Surgical repair has significant in-hospital mortality (6.9-12.6%) and high healthcare costs. Endovascular stent grafting has 15.2% all-cause mortality and 9.3% re-intervention rates. Percutaneous vascular plug/occluder technology emerged as a potentially safer and cheaper alternative to surgical AP closure. We will share our experience with this technology to enhance its success rate, safety, and cost-effectiveness. Methods: We retrospectively reviewed percutaneous AP closure cases with vascular plug/occluder technology published (2005 - 2016) and analyzed them alongside those performed at our institution (2017 - 2019). Results: We identified 40 cases of percutaneous AP closure with vascular plug/occluder technology in the literature and 10 performed at our institution. Our patients had a 1.9-day average length of stay with 100% successful targeted AP closure compared to 92% in the literature group. Over a 12-month median follow-up period (range 3-47 months), AP demonstrated stable or reduced sac size in 6 (60%) of our cases but increased in 4 (40%), necessitating surgical intervention. Literature cases had a 2-month median follow-up period with a 65% success rate. Death occurred in 40% of our patients from non-AP-related causes and in 8% of the literature group from AP closure-related complications. The cost per procedure was $49,580, which is hypothetically less than open surgical repair. Conclusion: Our experience shows a viable option for vascular plug/occluder technology in percutaneous AP repair, given its initial safety and cost-effectiveness. Our results highlight the critical role of follow-up imaging in identifying AP expansion and the need for further intervention. The high non-aorta-related mortality seen in follow-up emphasizes the high-risk nature of the population due to co-morbidities. .