Treatment of Coral Reef Aorta by Endovascular VIABAHN VBX Balloon-Expandable Stent-Graft Placement

Abstract

Coral reef aorta (CRA) has been described as a rare disease characterized by the presence of dense calcifications of the aorta. In this study, we report on two patients with CRA caused by intermittent claudication (IC) who underwent endovascular VIABAHN VBX balloon-expandable stent-graft (VVBX) placement. Both patients underwent successful endovascular VVBX placement via transfemoral artery approach, and hemostasis was achieved via vascular closure device. Their symptoms were observed to disappear completely after treatment, and they were discharged without serious adverse events. No symptoms were noted at 1.5-year and 1-year follow-up.

Challenging Endovascular Treatment of Coral Reef Aorta and a Literature Review

“…7 The symptoms depend on the extent of the disease and involvement of aorta branches, causing mainly intermittent claudication and critical ischemia of the lower limbs and the viscera, while symptoms such as heart failure, renovascular hypertension, abdominal angina, acute kidney injury, and congestive heart failure have also been reported in the literature. [6][7][8] The main symptom of our patient was the critical ischemia of the extremities, in the context of peripheral arterial disease, which led the patient to the hospital for the first time for further treatment. Although the patient met almost all the risk factors for atherosclerotic disease, he was not receiving any medication with aspirin and statin.…”

“…The symptoms depend on the extent of the disease and involvement of aorta branches, causing mainly intermittent claudication and critical ischemia of the lower limbs and the viscera, while symptoms such as heart failure, renovascular hypertension, abdominal angina, acute kidney injury, and congestive heart failure have also been reported in the literature. 6 7 8…”

“…Endarterectomy, angioplasty, extra-anatomic bypass, stent placement, and stent-graft placement have already been identified as treatments for CRA. 7 8 Surgical treatment is challenging and can result in highly morbid complications and death, while extensive and circumferential calcification lurks difficulties for endovascular therapy. 4 However, there is general acceptance that the surgical open technique is associated with high rates of perioperative mortality (8.7–11.6%) and serious postoperative complications.…”

“…7 In the last decade, the endovascular method seems to make its appearance and is the protagonist in the treatment of selected patients with CRA who cannot be treated with the open method. According to the current literature and platforms, the terms “endovascular stent-graft therapy” and “coral reef aorta” coexist and appear since 2008, and since then, only 13 articles ( Table 1 ) 3 4 5 8 10 11 12 13 14 15 16 17 18 have been published, most of them in the past 3 years. This is probably because vascular surgeons' familiarity with the endovascular technique and the appearance of newer and more advanced endovascular tools encourage vascular surgeons to dare to use the method.…”

“…Recorded cases of endovascular treatment with stent graft of coral reef aorta reported in bibliographic databases and platforms[3][4][5]8,[10][11][12][13][14][15][16][17][18] …”