Percutaneous Endovascular Repair of Aneurysm After Previous Coarctation Surgery

Abstract

Background-Formation of aortic aneurysm late after surgical repair of coarctation carries a significant risk of rupture and lethal outcome, and repeat surgery is associated with a 14% in-hospital mortality rate and morbidity from paraplegia, injury to the central nervous system, or from bleeding. The potential of nonsurgical endovascular repair by the use of stent-grafts in lieu of repeat surgery for postcoarctation aneurysm is unknown. Methods and Results-The concept of postsurgical endovascular stent-graft placement was evaluated with respect to feasibility and safety in 6 consecutive patients with late aneurysm formation after coarctation repair. All patients had aneurysm formation late after patch aortoplasty; placement of an elephant trunk during surgical repair of secondary type I dissection preceded formation of a local aneurysm in 2 cases. Patient age was 49Ϯ12 years, ranging from 31 to 68 years. Transluminal placement of customized stent-grafts was successful, with no 30-day or 1-year intervention-related mortality or morbidity. Follow-up survey of 11 to 47 months revealed optimal reconstruction of the thoracic aorta; 1 patient died 11 months after endovascular repair from cancer. Conclusions-Nonsurgical

Interventional Catheterization in Adult Congenital Heart Disease

“…17,18 Caution should be exercised, however, in regard to differing risks attributed to covered stents, including stent thrombosis, in-stent restenosis, and inability to redilate such stents at future settings.…”

Massive hemoptysis, the etiology is aorto-bronchial fistula

“…Surgical techniques for repairment of coarctation, include Dacron patch plasty, left subclavian flap aortoplasty and coarctectomy with end-to-end anastomosis. The primary techniques seem to be successful but pseudo aneurysms occur in %9 of patients after surgery (2). For the surgical treatment of aorta coarctation, Vosschulte defined the patch aortoplasty technique in 1957 for the first time as an alternative for resection and anastomosis.…”

Endovascular Covered Stent Treatment for Descending Aorta Pseudoaneurysm Following Coarctation of the Aorta Repair in an Infant

“…Early or late development of an aortic pseudoaneurysm is a recognised but rare complication following coarctation of the aorta repair [1]. It is more common after patch aug- mentation of the aorta than after end-to-end anastomosis [1,2].…”

“…It is more common after patch aug- mentation of the aorta than after end-to-end anastomosis [1,2]. It is often seen in patients with aortic arch hypoplasia [3,4].…”

“…Surgical management of a pseudoaneurysm post-coarctation repair is usually associated with high morbidity and mortality [1]. Currently, endovascular treatment to isolate pseudoaneurysms of the aorta is widely used in the adult population, with good outcomes [1].…”