Aortic graft pseudoaneurysm secondary to fracture of sternal wires

A 74-year-old man with a previously placed ascending aortic graft was admitted to our hospital with a pulsating sternal mass, 2 days after an episode of severe coughing. Six months earlier, computed tomographic scanning had shown an intact aortic graft and no sternal wire fracture, but the wires had cut through the sternum. Computed tomographic scans at the current admission showed the patient to have 2 perforations of the ascending aortic graft, which led to 2 pseudoaneurysms and a large subcutaneous hematoma. In another view, a fractured sternal wire could be seen leading to one of the pseudoaneurysms. We performed emergent surgery and found sternal separation, as well as 2 holes in the graft that coincided with the location of the fractured sternal wires. We successfully patched the graft; however, the patient had a cerebral ischemic stroke and died 2 weeks postoperatively. This case emphasizes the importance of early removal of loosening sternal wires.