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I read the study by Hegeman et al. [1] on transcatheter closure of postsurgical aortic pseudoaneurysms (PTAPs) with great interest but found two significant oversights in their work. Firstly, Matsuzawa et al. [2] did not report a 61% mortality rate in untreated PTAPs. In the same issue of the Netherlands Heart Journal, de Winter et al. [3] correctly identified Mulder et al. [4] as the source. However, Mulder’s study focuses on false aneurysms in the aortoiliac or aortofemoral region, not the ascending aorta, where the PTAPs of Hegeman et al. are located. Furthermore, Mulder’s reported 61% mortality rate from ruptures is actually only 44% (8 of 18 patients), a significant discrepancy.
Secondly, Hegeman et al. overlooked two vital treatment options: percutaneous transthoracic treatment [5] and a conservative approach for asymptomatic patients [6]. This omission is crucial, as 2 of 11 patients in their study died post-treatment. Incorporating these methods could potentially offer safer alternatives and improve patient outcomes.
References
Hegemann RRMJJ, Swaans MJ, Kara B, et al. Transcatheter closure of postsurgical aortic pseudoaneurysms guided by three-dimensional image reconstruction: a single-centre experience. Neth Heart J. 2023;31:383–9.
Matsuzawa T, YamabeK KM. et al. Successful endovascular treatment of an ascending aortic pseudoaneurysm using an AmplatzerVascularPlug II. Gen. Thorac Cardiovasc Surg. 2021;69:91–3.
de Winter RJ. Percutaneous closure of postsurgical thoracic aorta pseudoaneurysms: the why, when, and how. Neth Heart J. 2023;31:379–81.
Mulder EJ, van Bockel JH, Maas J, et al. Morbidity and mortality of reconstructive surgery of noninfected false aneurysms detected long after aortic prosthetic reconstruction. Arch Surg. 1998;133(1):45–9.
Hao F, et al. Percutaneous transthoracic treatment of ascending aortic and root pseudoaneurysms: procedural aspects and guidance with the use of multimodality imaging. J Vasc Interv Radiol. 2018;29:628–31.
Chaud GJ, et al. Aortic pseudoaneurysm after type A aortic dissection: results of conservative management. Semin Thorac Cardiovasc Surg. 2023;35:457–64.
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Bervoets, B. Revisiting postsurgical aortic pseudoaneurysm mortality and treatment options. Neth Heart J (2024). https://doi.org/10.1007/s12471-024-01867-7
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DOI: https://doi.org/10.1007/s12471-024-01867-7