Treatment of Symptomatic Coral Reef Aorta by Endovascular Stent-Graft Placement

Holfeld, Johannes; Gottardi, Roman; Zimpfer, Daniel; Dorfmeister, Marion; Dumfarth, Julia; Funovics, Martin; Schoder, Maria; Weigang, Ernst; Lämmer, Johannes; Wolner, Ernst; Czerny, Martin; Grimm, Michael

doi:10.1016/j.athoracsur.2007.11.053

Cited by 45 publications

(46 citation statements)

References 5 publications

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“…Stentgrafting might be limited by the lack of self-expanding capacity of the graft. In addition, paraplegia due to spinal ischemia and distal embolization can occur [7]. Centa et al stated that patients should be excluded from laparoscopic therapy when coral reef lesions extend around the visceral arteries [8].…”

Section: Discussionmentioning

confidence: 98%

“…The general condition of such morbid patients at the time of referral is usually sick, thereby potentially prohibiting conventional surgical repair consisting of multilevel invasive surgical exposure of target vessels [4]. Other less invasive strategies using scopic or endovascular devices have been described [7,8]. However, some defects are associated with these approaches.…”

Section: Discussionmentioning

confidence: 98%

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Congestive heart failure due to coral reef thoracoabdominal aorta

Sato

Sakurai

Kaneda

et al. 2011

Interactive CardioVascular and Thoracic Surgery

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Acquired coarctation due to coral reefs is a rare and unique entity characterized by extensively calcified thrombus of the entire aorta. There are few reports of coral reef aorta resulting in severely congestive heart failure in the literature. We describe a 60-year-old female with acute heart failure. Computed tomography (CT)-scan and magnetic resonance imaging (MRI) revealed that the cause of the heart failure was cardiac after-load mismatch due to serious stenosis of the aorta. In order to prevent cardio-respiratory failure, an axillofemoral bypass was performed to release the cardiac after-load mismatch. This diminished the pressure gradient between upper and lower blood pressure that caused cardiac dysfunction.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Congestive heart failure due to coral reef thoracoabdominal aorta

Sato

Sakurai

Kaneda

et al. 2011

Interactive CardioVascular and Thoracic Surgery

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show abstract

“…They are not suitable for elderly patients and patients whose general statuses are not well because they require quite invasive approaches such as aortic clamp, thoracotomy and/or celiotomy. Endovascular stent graft placement is not very invasive, 7) but, especially in TA patients, it was reported that surgical repair was associated with low mortality and morbidity compared with endovascular repair. 8) In highly calcified lesions, underdilation, fracture, and rupture of stent grafts were expected.…”

Section: Discussionmentioning

confidence: 99%

Axillofemoral Bypass Markedly Improved Acute Decompensated Heart Failure and Kidney Injury in a Patient with Severely Calcified Stenosis of Thoracoabdominal Aorta (Atypical Aortic Coarctation)

et al. 2017

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SummaryAtypical aortic coarctation (AAC) has been reported to occur anywhere along the aorta, except for the ascending aorta. The associated symptoms include hypotension in the lower half of the body, secondary hypertension in the upper half of the body, and heart failure. Here we present an 80-year-old Asian woman complaining of progressive exertional dyspnea. She was diagnosed with acute decompensated heart failure and kidney injury due to severely calcified stenosis of the thoracoabdominal aorta, the so called AAC. She received hemodiafiltration, and pulmonary congestion improved in part. Generally, surgical treatments are quite invasive in elderly patients. Endovascular stent graft placement is less invasive, however, fracture and rupture should be considered at severely calcified lesions like this case. Therefore, we selected extra-anatomical axillofemoral bypass. Her recovery after the surgery was remarkable. In a few days, she became free from hemodiafiltration, intravenous diuretics, and oxygen administration. We thought the contributive factors are the increase in kidney blood flow and the correction of afterload mismatch. The decrease in pulse pressure may reflect the reduction in systemic arterial compliance by axillofemoral bypass. The operative mortality of axillofemoral bypass was reported to be acceptable, although the patency of the axillofemoral bypass graft was not high enough. In conclusion, axillofemoral bypass is effective and feasible for elderly patients with acute decompensated heart failure and kidney injury due to AAC.(Int Heart J 2017; 58: 820-823)

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“…Recent improvements in endovascular techniques have enabled patients to be successfully treated with uncovered, self-expanding or rarely covered stent grafts. Covered stent grafts have limited utility in this disease secondary to an inability to expand and complications including paraplegia from occlusion of the side branch 5. The decision to intervene is highly patient dependent and is often based largely on symptoms, comorbidities and surgical risk.…”

Section: Treatmentmentioning

confidence: 99%

Thromboatheromatous coarctation of the aorta diagnosed with intraoperative TOE during emergent open aneurysm clipping

McNeil¹,

Kleiman

Nemergut

et al. 2018

BMJ Case Reports

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A woman in her 50s presenting for emergent intracranial surgery was discovered to have a large incongruity in blood pressure between her right arm and her other extremities. Intraoperative rescue transoesophageal echocardiography (TOE) revealed a large thromboatheromatous burden in her descending aorta resulting in a functional coarctation. Usually diagnosed via CT imaging, we present what we believe to be the first published case diagnosed intraoperatively using TOE. After the diagnosis was made, blood pressure goals were adjusted to provide sufficient perfusion distally and her surgery was completed otherwise uneventfully.

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Treatment of Symptomatic Coral Reef Aorta by Endovascular Stent-Graft Placement

Cited by 45 publications

References 5 publications

Congestive heart failure due to coral reef thoracoabdominal aorta

Congestive heart failure due to coral reef thoracoabdominal aorta

Axillofemoral Bypass Markedly Improved Acute Decompensated Heart Failure and Kidney Injury in a Patient with Severely Calcified Stenosis of Thoracoabdominal Aorta (Atypical Aortic Coarctation)

Thromboatheromatous coarctation of the aorta diagnosed with intraoperative TOE during emergent open aneurysm clipping

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