A 78-year-old woman who had undergone an axillobifemoral artery bypass with a prosthetic graft for Leriche syndrome presented 1 month later with cough and fever. A clinical examination revealed obvious redness in the right groin. Routine laboratory tests uncovered inflammation and methicillin-sensitive-Staphylococcus aureus was cultured from blood samples. Mitral valve vegetations were identified by echocardiography, and after a diagnosis of infective endocarditis, specific intravenous antibiotics were immediately administered. One month later, CT revealed a large pseudoaneurysm of the posterior left ventricular wall that had not been present at the time of admission. Transesophageal echocardiography and magnetic resonance imaging showed an aneurysmal cavity arising from the wall just below the posterior mitral valve leaflet. The patient agreed to undergo cardiac surgery due to the high likelihood that the pseudoaneurysm would rupture. The mitral annulus and leaflet were normal at surgery. We resected the posterior leaflet, closed the cavity using a Xenomedica patch, and reconstructed the leaflet. We did not remove the pseudoaneurysm using an extracardiac approach because the likelihood of damaging the coronary arteries and the coronary sinus was quite high. The postoperative course was uneventful. At follow-up 1 year later, the patient was afebrile and both CT and echocardiography showed that the cavity was completely filled by the thrombus. The imaging findings were useful in determining the surgical approach.

Thoracic Endovascular Aortic Repair (TEVAR) is widely used for high-risk patients with thoracic aortic pathology. However, access to the thoracic aorta can be difficult because TEVAR requires the introduction of a large a sheath especially in those with aortoiliac occlusive diseases and thoracic shaggy aorta. We herein report two cases of TEVAR in which the common carotid artery was used as the access route. Case 1 : An 86-year-old male patient whose past surgical history was significant for infected abdominal aortic aneurysm with abdominal aortic stump closed and axillo-bilateral femoral bypass. Computed tomography revealed a saccular aneurysm of the descending aorta, which required a carotid artery approach as the access route. Case 2 : A 79-year-old female patient who developed type A thoracic aortic dissection. She was considered to be of prohibitive risk for surgical repair and was treated conservatively. However, an intramural hematoma with an ulcer-like projection lesion in the ascending aorta expanded and definitive treatment was indicated. Because the descending aorta was significantly shaggy, we decided to perform TEVAR via the right common carotid artery as the access route. Both patients' pathology was successfully treated and were discharged without any complications. TEVAR via common carotid artery access is a useful and safe procedure for patients in whom femoral and abdominal aortic aorta access is not feasible or safe.