Late development of dissecting aneurysm following balloon angioplasty of native aortic coarctation

Abstract

Acute aortic dissection during balloon angioplasty for coarctation of the aorta or aneurysm formation during follow-up are well-known complications of this procedure. Dissecting aneurysm development during long-term follow-up after balloon angioplasty of a native coarctation has not been previously reported. We report a case in which a huge dissecting aneurysm developed 3 years after the native coarctation angioplasty procedure. The aneurysm required surgical repair.

Stent implantation for aortic coarctation and recoarctation

“…Within the first year of life, and particularly within the first month, the high restenosis rate and the rate of femoral arterial complications after balloon dilatation of aortic coarctation supports surgical repair as the preferred option 2-5. In older patients, however, balloon dilatation of both native and aortic recoarctation has a higher success rate with a lower incidence of restenosis than in infancy1-8 but there are concerns about acute aortic dissection7 9 and the late development of aneurysms 1011 It is of note that aneurysm formation is a recognised complication after various types of surgical repair,12 13 particularly when the results are evaluated by routine magnetic resonance imaging 14…”

Transcatheter Treatment of Coarctation of the Aorta: A Review

“…Studies with follow-up of up to 90 months and systematic screening by chest radiographs, angiography, or magnetic resonance imaging, report an incidence of 5% for the presence (or development) of an aneurysm [90,120]. Even if current reported rates of aneurysm formation remain low, there remains concern about long-term outcomes, including impact upon the risk of dissection [7,79], arterial wall structural integrity in the face of the potential of late development of systemic hypertension, and in situations such as pregnancy, when histologic changes in the arterial wall occur [85,162], close followup in the surgically treated patient is mandatory.…”

Late thoracic aortic dissecting aneurysm following balloon angioplasty for recoarctation after subclavian flap aortoplasty in childhood?successful surgical repair under circulatory arrest

“…Higher rates of aneurysm formation can be explained by the 'cystic medial necrosis' theory that predisposes this area to dissection and aneurysm formation following BA. In patients who have undergone SFA, residual abnormal coarctation tissue is present, which is inherently weak, and dilation can cause dissection and aneurysm formation [7][8][9]. Surgical management is a challenge as aneurysms are large, adherent to lung, and the whole hemithorax is extremely vascular due to numerous collaterals.…”