“Coral reef” atherosclerosis of the suprarenal aorta: A unique clinical entity

Qvarfordt, Peter; Reilly, Linda M.; Sedwitz, Marc M.; Ehrenfeld, William K.; Stoney, Ronald J.

doi:10.1016/0741-5214(84)90023-5

Cited by 45 publications

(61 citation statements)

References 5 publications

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“…In 1984, Qvarfordt et al were the first to identify a rare subset of calcifying aortic disease localized to the suprarenal aorta. 1 They described narrowing of the aortic lumen comprising visceral, renal, and lower extremity perfusion in a group of nine middle-aged women. The cause of aortic obstruction was a rockhard, irregular, gritty intraaortic mass with a white luminal surface resembling coral reefs.…”

Section: Introductionmentioning

confidence: 99%

Coral Reef Aorta: A Long-Term Study of 21 Patients

Schulte

Reiher

Grabitz

et al. 2000

Annals of Vascular Surgery

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Section: Introductionmentioning

confidence: 99%

Coral Reef Aorta: A Long-Term Study of 21 Patients

Schulte

Reiher

Grabitz

et al. 2000

Annals of Vascular Surgery

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“…2 A similar nosologic entity is the ''coral reef aorta,'' which however involves the portion between the diaphragm and the suprarenal part of this vessel (visceral aorta). 3 Mild stenosis may be completely asymptomatic; with the progression of the disease, symptoms may arise, such as dyspnea, lipothymic episodes, fatigue, headache, upper limb hypertension, and lower limb hypoperfusion with claudication. 1 Diagnostic suspicion of a steno-occlusion of the thoracic aorta may be prompted by echo-color Doppler findings of poststenotic blood flow abnormalities in the splanchnic and renal arteries and the downstream vessels bilaterally, as seen in this patient.…”

Section: Discussionmentioning

confidence: 99%

Open Surgical Treatment of a Severe Case of Obstructive Calcifying Aortic Disease

Rispoli

Varetto

Castagno

et al. 2015

Annals of Vascular Surgery

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The obstructive calcifying aortic disease refers to severe calcifications of the descending aorta that obstruct or slow blood flow. Here, we report the case of a 65-year-old woman with recent onset of a very tight intermittent claudication and concomitant severe and uncontrolled hypertension, treated with a bypass graft between the proximal descending thoracic aorta and the supravisceral abdominal aorta.Severe stenosis or total occlusion of the descending aorta usually involving the origin of the visceral and renal arteries is a rare pathologic entity usually called middle aortic syndrome. 1 The commonest etiologies are congenital disorders or inflammatory disease, and adolescents or young people are more commonly affected. Herein, we describe the case of an unusual localization limited to the descending aorta and not involving the visceral vessels without any congenital or inflammatory explanation. CASE REPORTA 65-year-old woman was admitted to our department because of worsening intermittent claudication of the lower limbs and uncontrolled severe hypertension despite 3 medications (b blockers, diuretic, a1-adrenergic blocker). Her past medical history also included type 2 diabetes mellitus treated with oral hypoglycemic agents and dyslipidemia treated with statins; no history of smoke was present. Over the past months, she experienced worsening of general health, with episodes of intense asthenia, headache, dizziness and disorientation, and dyspnea after mild exertion. Physical examination revealed bilateral hyposphygmic femoral pulses and the absence of peripheral pulses. Ankle-brachial index (ABI) was 0.3 on both sides.Echo-color Doppler of the proximal abdominal aorta and iliac arteries showed poststenotic flow in the celiac trunk, superior mesenteric artery, both renal arteries, and the iliac and femoropopliteal axes bilaterally. The supra-aortic vessels appeared normal. Echocardiography demonstrated mild left ventricular hypertrophy, ectasia of the ascending aorta, and calcific stenosis of the descending aorta downstream from the isthmus. A computed tomography angiography (CTA) showed a normal ascending aorta and aortic arch, a severely calcified descending aorta with a pseudocoarctation in the proximal portion (18-mm diameter) and tight stenosis in the mid-distal segment, with reduction of the vessel lumen to a few millimeters just above the celiac trunk (Fig. 1). The splanchnic arteries, the infrarenal aorta, and the renal and the iliac arteries, although severely hypoperfused, were all morphologically normal and free from calcifications.Preoperative blood chemistry showed no significant anomalies. Spirometry demonstrated mild-to-moderate restrictive lung function. Coronary angiography revealed no abnormalities of the coronary arteries, and aortography showed an 85emm Hg pressure gradient at the lower extremity of the restricted aorta. Total body positron emission tomography was performed to rule out focal inflammatory processes in the aorta, but it did not show any abnormal tracer distribution. Antibod...

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“…Coral reef aorta refers to hemodynamically significant supra-renal narrowing of aorta with rock-hard like dense calcifications resembling coral reef protruding into the lumen [2]. Clinical presentation of coral reef aorta could be upper body hypertension, cerebrovascular accident, congestive heart failure and acute renal failure.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

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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“Coral reef” atherosclerosis of the suprarenal aorta: A unique clinical entity

Cited by 45 publications

References 5 publications

Coral Reef Aorta: A Long-Term Study of 21 Patients

Coral Reef Aorta: A Long-Term Study of 21 Patients

Open Surgical Treatment of a Severe Case of Obstructive Calcifying Aortic Disease

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

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