Acquired coarctation due to calcified thrombus in atherosclerosis of the descending thoracic aorta Two cases and a review

Sadony, V.; Kayambo, G. H.; Walz, Matthias; Serdarevic, M

doi:10.1016/1010-7940(89)90059-6

Cited by 8 publications

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“…Coral reef aorta is essentially treated by conventional surgery comprising thromboendarterectomy, resection of the calcified thrombus and graft replacement of the aorta, or placement of a thoracoabdominal bypass graft [1][2][3][4][5][6]. These direct aortic surgeries are more invasive, and some authors have described an operative mortality rate of 8.7-11.6% and a 13.9-15.9% rate of postoperative complications requiring corrective surgery [2,5].…”

Section: Discussionmentioning

confidence: 99%

“…Axillofemoral extra-anatomical bypass grafting takes less operative time, a shorter period under anesthesia and a smaller skin incision than other direct aortic therapies [1][2][3][4][5][6]8] and it does not require aortic cross clamping that can confer cardiac after loading. Donaldson et al reported an operative mortality rate of 1.1% for axillofemoral bypass grafting [9].…”

Section: Discussionmentioning

confidence: 99%

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Congestive heart failure due to coral reef thoracoabdominal aorta

Sato

Sakurai

Kaneda

et al. 2011

Interactive CardioVascular and Thoracic Surgery

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Acquired coarctation due to coral reefs is a rare and unique entity characterized by extensively calcified thrombus of the entire aorta. There are few reports of coral reef aorta resulting in severely congestive heart failure in the literature. We describe a 60-year-old female with acute heart failure. Computed tomography (CT)-scan and magnetic resonance imaging (MRI) revealed that the cause of the heart failure was cardiac after-load mismatch due to serious stenosis of the aorta. In order to prevent cardio-respiratory failure, an axillofemoral bypass was performed to release the cardiac after-load mismatch. This diminished the pressure gradient between upper and lower blood pressure that caused cardiac dysfunction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Congestive heart failure due to coral reef thoracoabdominal aorta

Sato

Sakurai

Kaneda

et al. 2011

Interactive CardioVascular and Thoracic Surgery

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“…6 In most cases, thrombus formation involves the thoracic segment. 5,7 As with the present case, adults should present to the cardiovascular or hypertension clinic with resistant upper extremity hypertension.…”

Section: Discussionmentioning

confidence: 63%

“…4,5 A literature search of Englishlanguage journals over the last 35 years have turned up cases only in paediatric patients. 6,7 For example, infants with classical features of aortic coarctation were found instead to have aortic thrombus formation in association with umbilical artery catheter placement.…”

Section: Discussionmentioning

confidence: 99%

A case of resistant hypertension in a 69-year-old man

2002

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A 69-year-old man presented with resistant hypertension, symptoms of calf claudication, faint femoral pulses and relative lower limb hypotension, suggestive of aortic coarctation. CT scanning revealed extensive arterial thrombosis from his lower abdominal aorta to Keywords: resistant hypertension; calf claudication; lower limb hypotension A 69-year-old Caucasian male was referred with a 10-year history of 'resistant' hypertension. Previous investigations prior to referral to our specialist hypertension clinic had ruled out renal and neuroendocrine causes of hypertension, which included renal artery stenosis, carcinoid syndrome and phaeochromocytoma. He was taking an unusual combination of enalapril 5 mg, valsartan 80 mg, nifedipine 20 mg, and amlodipine 5 mg. Despite a diagnosis of ischaemic heart disease since 1979 and bilateral intermittent calf claudication since 1984, he was not taking aspirin. He reported at least three occasions when his claudication distance deteriorated acutely, and then spontaneously improved. At presentation, his claudication distance was about 100 yards, equally affecting both lower limbs. He was smoking, on average, in excess of 10 cigarettes daily for the last 50 years.On initial examination, he was found to have an upper limb blood pressure of 218/90 mm Hg, a soft ejection systolic murmur at the aortic area and no clinical evidence of heart failure. Both radial and brachial pulses were strong and equal bilaterally. There was no significant radio-femoral delay, although both femoral pulses were weak, as were his pedal pulses. His lower limb systolic blood pressures by palpation, were 180 mm Hg bilaterally. His feet however, were warm and well perfused, indicating a chronic process, with no clinical evidence of neuropathy.Serum creatinine, plasma viscosity and erythrocyte sedimentation rate (ESR) were normal, whilst a both common iliac arteries as the aetiology of his apparent manifestation of aortic coarctation.

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“…Very few case reports of acquired atheromatous coarctation of aorta has been reported, but the patients were usually treated surgically in these case reports [5][6][7]. In our case, we had performed CT angiography one week prior to the current admission and hence we knew the diagnosis beforehand.…”

Section: Discussionmentioning

confidence: 99%

Urgent Aortic Stenting for Acquired Atheromatous Coarctation of Aorta Presenting as Acute Aortic Obstruction and Multiorgan Failure

Ezhumalai¹

2017

JCTCD

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Abstract65 years gentleman presented to emergency department with upper body hypertensive urgency, heart failure and renal shut down. He had recently undergone aortography and CT angiography which revealed severe atheromatous narrowing of upper descending thoracic aorta, well below the origin of left subclavian artery, with maximal stenosis of 85% at D5-D6 vertebrae level. Urgent aortic stenting with covered stent saved this patient with acquired atheromatous coarctation presenting as acute aortic obstruction and multiorgan failure. IntroductionNarrowing of aorta can occur due to various aetiologies. It can be localised or segmental depending on the etiology [1]. The most common congenital reason for this narrowing of aorta is Coarctation of Aorta (COA) [1]. The other etiologies are pseudocoarctation, aortoarteritis, takayasu's arteritis, middle aortic syndrome, atherosclerosis, coral reef aorta etc [1][2][3][4][5]. We are reporting a case of acquired atheromatous coarctation of aorta presenting as acute aortic obstruction and multiorgan failure caused by severe atheromatous narrowing of aorta which was treated on an urgent basis with aortic stenting. Case Report65 years old gentleman presented with breathlessness (NYHA class III) and accelerated hypertension with a Blood Pressure (BP) of 182/104 mmHg. He had undergone coronary angioplasty with stents to LAD and LCX 4 years ago. Electrocardiography showed non-specific ST-T changes while his echocardiography was normal except for grade 3 diastolic dysfunction. All laboratory tests were normal. Both kidneys were ultrasonographically normal.Transfemoral coronary angiography revealed patent stents with no critical obstruction; renal angiography also was normal. His femoral pulses were feeble and there was difficulty in negotiating 0.035" Terumo guidewire and 5F diagnostic catheter through upper descending thoracic aorta during coronary angiography. So aortography was performed with 5F pigtail catheter which demonstrated long segment severe stenosis of upper descending thoracic aorta well below the origin of left subclavian artery (Figure 1, panel A). Mutli-slice CT angiography revealed gross

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Acquired coarctation due to calcified thrombus in atherosclerosis of the descending thoracic aorta Two cases and a review

Cited by 8 publications

References 0 publications

Congestive heart failure due to coral reef thoracoabdominal aorta

Congestive heart failure due to coral reef thoracoabdominal aorta

A case of resistant hypertension in a 69-year-old man

Urgent Aortic Stenting for Acquired Atheromatous Coarctation of Aorta Presenting as Acute Aortic Obstruction and Multiorgan Failure

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