Treatment of symptomatic coral reef aorta with an uncovered stent graft

Abstract

Coral reef aorta is a rare condition characterised by extreme calcific growths affecting the juxta and suprarenal aorta. It can cause symptoms due to visceral ischaemia, lower limb hypoperfusion, and distal embolisation. We present a case of a 61-year-old man with unresponsive hypertension, who was found to have an occluded right renal artery, and an extensive coral reef aorta with a marked pressure gradient across the lesion. Renal hypoperfusion secondary to aortic coral reef aorta was thought to be the cause for his hypertension. Endovascular placement of a balloon expandable uncovered stent resolved his hypertension within one month, with no adverse effects noted at subsequent follow-up. Endovascular treatment of coral reef aorta is technically possible and avoids a major vascular procedure.

Challenging Endovascular Treatment of Coral Reef Aorta and a Literature Review

“…Endovascular treatment of CRA is technically possible and exempts the vascular surgeons from the concern of complex and difficult patients, deemed unsuitable for open vascular intervention. 12…”

Endovascular Treatment of Acquired Atheromatous Postsubclavian Aortic Coarctation

“…Their pathogenesis has been attributed by some to calcification of a fibrin-platelet thrombus, but atherosclerotic risk factors do not sufficiently explain the extensive calcification and metaplastic bone formation. 4,5 Surgical treatment of coral reef aorta-with thromboendarterectomy, calcified thrombus resection, stent-graft placement, or extraanatomic bypass-is associated with high rates of operative mortality and postoperative complications. 3 Frequent postoperative complications include acute leg ischemia, pleural effusion, bleeding, brain infarction, myocardial infarction, spleen rupture, terminal renal insufficiency, necrotizing pancreatitis, and colon ischemia.…”

“…8 However, endovascular treatment is not routinely attempted in a coral reef aorta because the risk of aortic rupture is high and because incomplete stent expansion can limit the effectiveness of stent-grafts. 4,5,9 In our patient, we used a balloon-expandable covered stent to avoid rupture, despite the risk of dissection proximally into the subclavian artery. Such a complication would have necessitated emergency plugging of…”

“…3 Extensive and circumferential calcification poses difficulties for endovascular therapy. 4,5 Calcification of the postsubclavian aorta can lead to acquired atheromatous coarctation. 6,7 We present the case of a young man with an acquired atheromatous coarctation of the postsubclavian aorta.…”

Treatment of symptomatic coral reef aorta by a nitinol self-expanding stent

“…We preferred non-graft stent in the index case as there was an inadequate landing zone between CRA and the origin of celiac artery, that is, 10 mm, and a few spinal arteries were arising just above the CRA site. Few authors have used non-graft balloon expandable stent in CRA,6 7 which can have the risk of rupture of the calcified aorta 8. We preferred nitinol self-expanding stent to cover the CRA and also iatrogenic aortic dissection following balloon dilatation.…”