Fig 1. Pretreatment computed tomography angiogram demonstratingisolated left subclavian artery aneurysm as well as Kommerell’s diverticulumand right-sided aortic arch.

Fig 2.

JOURNAL OF VASCULAR SURGERY1736 Abstracts December 2013

Results: The patient’s postoperative course was uneventful withrespect to stroke or new upper extremity symptoms, however he didundergo cardioversion for atrial fibrillation with rapid ventricular responseshortly after the implantation of the thoracic endograft. During follow-upthere has been a steady improvement in his upper extremity brachial plexusinjuries with physical therapy. There was a resolution of differential upperextremity blood pressure measurements following the procedure.

Conclusions: To our knowledge, this is the first reported case of anisolated subclavian artery aneurysm associated with a right-sided aorticarch and Kommerell’s diverticulum. Hybrid endovascular repair is an effec-tive way of treating this rare complex problem.

Novel Transcatheter AngioVac Utilization and Endovascular StentGraft Placement for the Treatment of Symptomatic PrimaryThoracoabdominal Mural and Floating Intra-Aortic ThrombusJoseph H. Habib, James Cunningham, Kristy Cosgrove. University ofFlorida, Jacksonville, Fla

Introduction: Primary aortic mural thrombus in a nonaneurysmalnonatherosclerotic aorta is an uncommon clinical finding. Catastrophicembolic complications may occur if the thrombus is mobile. Patient presen-tation is variable and can include arterial thromboembolism with potentialof visceral and peripheral involvement.

Management of spontaneous aortic mural thrombus has remainedpoorly defined. Therapeutic options include anticoagulation, thrombolysis,balloon catheter thrombectomy, aortic replacement, and endovascularexclusion. Anticoagulation alone can result in a high rate of continuedembolization while high morbidity and mortality rates may accompanyopen surgical options such as thoracoabdominal aortic replacement. TheAngioVac system (Angiodynamics, Latham, NY) is intended for use asa venous drainage cannula for removal of venous or tumor thrombusfrom the ileocaval system and right heart chambers during extracorporealbypass. The device is inserted through a cannula into the venous system.A return cannula is placed into the venous system to complete the circuit.The cannulas are connected to an extracorporeal pump and negative pres-sure is generated up to 80 mm Hg. The negative pressure functions toremove the intravascular debris in an en-bloc fashion. The circuit includes

Fig 1.

Fig 2.

Fig 1.

Fig 2.

JOURNAL OF VASCULAR SURGERYVolume 58, Number 6 Abstracts 1737

a filter to trap the debris before re-infusing the blood. The use of AngioVacin the treatment of thrombus in the arterial system has yet to be described.We present the first case report of successful treatment of symptomatic thor-acoabdominal mural and floating intra-aortic thrombus using a thoracicendograft (C-TAG; W. L. Gore and Associates, Flagstaff, Ariz) in conjunc-tion with the AngioVac device.

Objectives: A 46-year-old female presented with primary aortic muralthrombus beginning mid descending aorta with extension distally into theceliac artery and evidence of visceral embolization demonstrated oncomputed tomography angiography (CTA) (Fig 1). The patient wastaken to the angiography suite for exclusion of the aortic thrombus with anendograft in conjunction with percutaneous celiac thrombectomy.

Methods: Follow-up CTA revealed thrombus extending frombeneath the distal landing zone of the endograft into the abdominal aortawhich appeared to be floating in the visceral segment.

The patient was brought back to the angiography suite for AngioVacthrombectomy. Bilateral femoral cutdowns were performed and the Angio-vac device was placed through the iliofemoral arterial system into theabdominal aorta with the return venous cannula placed in the contralateralfemoral vein.

Results: Successful extraction of the thrombus was achieved andconfirmed on follow-up CTA imaging (Fig 2).

Conclusions: This case demonstrates the effective utilization of anendograft and AngioVac thrombectomy as an effective treatment optionfor select patients with symptomatic primary thoracoabdominal aortic muralthrombus. Ease of use and low risk profile suggests this technique couldbecome a front line option for select patients. Long-term follow-up willbe necessary to assess durability of this technique.

Coil Embolization of a Ruptured Gastroduodenal Artery Pseudo-aneurysm Presenting with Hemosuccus PancreaticusNaveed U. Saqib, Joseph DuBose, Gordon H. Martin, Kristofer M.Charlton-Ouw, Sheila M. Coogan, Anthony L. Estrera, Hazim J. Safi,Ali Azizzadeh. University of Texas Medical School Houston andMemorial Hermann Heart and Vascular Institute, Houston, Tex

Objectives: Hemosuccus pancreaticus (HP), hemorrhage fromthe papilla of Vater, is a rare form of upper gastrointestinal (GI)bleeding (incidence: 1/1500 cases). Visceral artery pseudoaneurysms(VAPA) are secondary to chronic pancreatitis, are responsible for20% of HP cases and can occur in up to 10% of patients with chronicpancreatitis. Gastroduodenal artery (GDA) pseudoaneurysms areamong the rarest forms of VAPA (<2%). We report successful coilembolization of a ruptured GDA pseudoaneurysm in a patient withmassive GI bleeding.

Methods: A 68-year-old man with a history of chronic pancreatitisand cirrhosis presented to emergency room with a 7-day history of melenathat was followed by acute abdominal pain and shortness of breath. Onarrival, he was hypotensive with severe anemia (hemoglobin 4.2). Thepatient was aggressively resuscitated with transfusions. Next, an esophago-duodenoscopy was performed, which did not reveal the source of bleeding.A computed tomographic angiography of the abdomen and pelvis demon-strated a 4 cm GDA pseudoaneurysm without active extravasation. Thepatient was taken to the operating room for an aortogram and possiblecoil embolization.

Results: A transfemoral selective common hepatic artery and super-selective gastroduodenal angiogram was performed. The angiogramrevealed a large GDA pseudoaneurysm with a pancreatic duct fistula asthe source of the GI bleed. Contrast extravasation into the duodenumwas demonstrated on delayed images. A 6F sheath (Pinnacle Destination;Terumo) was placed in the main trunk of celiac artery, a 5F catheter (Gli-decath; Terumo) was placed in the common hepatic artery, and a 3Fmicrocatheter (Renegade; Boston Scientific) was placed in the aneurysmsac. The aneurysm sac was packed with Interlock Fibered IDC (BostonScientific) coils delivered via the microcatheter. Subsequently, the GDA