Role of endovascular repair in the management of late pseudo-aneurysms following open surgery for aortic coarctation

Abstract

Endovascular repair of pseudo-aneurysms following open surgery for aortic coarctation is feasible and safe. However, more patients and longer follow-up are necessary to assess the efficacy of this promising less-invasive alternative to open re-do surgery.

Most Coarctations, Recoarctations, and Coarctation-Related Aneurysms Should Be Treated Endovascularly

“…In 2009, Botta and associates [11] reported their experience using thoracic stent grafts in the treatment of CoA. They reported a 100% technical success rate, a 0% mortality rate, and a 0% reintervention rate after a mean follow-up period of 44 months.…”

“…Recently, use of covered stents has been advocated for CoA, recoarctation, and CoA-related aneurysms (Table 1) [3,[11][12][13][14][15][16][17][18][19]. In 2009, Botta and associates [11] reported their experience using thoracic stent grafts in the treatment of CoA.…”

“…In patients more than 1 year old, endovascular procedures have been shown to yield immediate outcomes similar to those of surgery, defined as hemody namically controlled hypertension in the follow-up period [4]. Any argument regarding endovascular reintervention, however negligible, is formidable, because such reintervention is associated with the same risks of morbidity and mortality as the initial operation [11]. Furthermore, belief in the longevity of surgical repair stenting was associated with significantly fewer complications [2.3% versus 8.1% for surgery and 9.8% for balloon angioplasty (p < 0.001)] and shorter hospital stays [2.4 days versus 6.4 days for surgery (p < 0.001)].…”

Endovascular stent placement is an acceptable alternative to reoperation in selected infants with residual or recurrent aortic arch obstruction

“…The fact that children will by necessity be committed to several future cardiac catheter procedures because of need for stent redilation causes concern for some thus preferring surgical alternatives or stent therapy as a bridge to definitive surgery later in childhood. Reoperation is, however, not without significant morbidity and mortality in young infants and would occasionally require patch aortoplasty with resulting long-term concerns of aortic integrity and the possibility of aneurysm formation [18]. Recent case series of surgical repair of recoarctation do, however, report encouraging mid-term results and it is in this context that endovascular stent therapy needs to be evaluated [19].…”

Thoracic Endovascular Aortic Repair for Treatment of Late Complications After Aortic Coarctation Repair

“…In one patient, a subclavian flap aortoplasty was performed, and for one patient, the primary procedure was unknown. The median age at the primary coarctation repair was 6 years (range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”