OBJECTIVE: Whatever the surgical technique used, false aneurysm formation is one of the long-term complications of repair of aortic coarctation. Conservative management is associated with a 100% rate of rupture. The conventional surgical approach is complex and associated with high morbidity and mortality rates. We report our experience of endovascular management of pseudo-aneurysms after previous surgical repair of congenital aortic coarctation. METHODS: Between October 2005 and 2006, stent-grafting of pseudo-aneurysms after previous surgical repair of congenital aortic coarctation was performed in four patients. Median age was 31.5 years (range: 24-38). Two patients had undergone two previous interventions. The last previous surgery consisted of graft interposition (N=2), subclavian flap aortoplasty (N=1) and aorto-aortic bypass (N=1). Median size of the pseudo-aneurysm was 31.5mm (range: 20-58). Mean time between the last surgery and endovascular treatment was 24 years (range: 3-32). One patient was treated emergently because of hemoptysis in relation with an aorto-bronchial fistula, the three other patients were treated electively. A transfemoral approach was used in all patients. The Zenith TX2 (Cook) thoracic stent-graft was used in all the patients, one patient underwent previous dilatation at the coarctation level. When present, the ostium of the left subclavian artery was always covered (N=3). RESULTS: No major complication occurred during the procedure and no patient died during the follow-up. One patient presented a type II endoleak which spontaneously healed during the first month. Another patient with his left subclavian artery covered presented claudication of the left arm requiring a carotid-subclavian bypass. After a median follow-up of 7.5 months (range: 1-12.9), the patients were asymptomatic and CT scans demonstrated complete exclusion of all treated postcoarctation aneurysms without recoarctation and without any stent-graft-related complication. CONCLUSIONS: The endovascular management of pseudo-aneurysms after previous surgical repair of congenital aortic coarctation is feasible. This approach was safe and effective. Long-term clinic and imaging follow-up is mandatory.
OBJECTIVE: Whatever the surgical technique used, false aneurysm formation is one of the long-term complications of repair of aortic coarctation. Conservative management is associated with a 100% rate of rupture. The conventional surgical approach is complex and associated with high morbidity and mortality rates. We report our experience of endovascular management of pseudo-aneurysms after previous surgical repair of congenital aortic coarctation. METHODS: Between October 2005 and 2006, stent-grafting of pseudo-aneurysms after previous surgical repair of congenital aortic coarctation was performed in four patients. Median age was 31.5 years (range: 24-38). Two patients had undergone two previous interventions. The last previous surgery consisted of graft interposition (N=2), subclavian flap aortoplasty (N=1) and aorto-aortic bypass (N=1). Median size of the pseudo-aneurysm was 31.5mm (range: 20-58). Mean time between the last surgery and endovascular treatment was 24 years (range: 3-32). One patient was treated emergently because of hemoptysis in relation with an aorto-bronchial fistula, the three other patients were treated electively. A transfemoral approach was used in all patients. The Zenith TX2 (Cook) thoracic stent-graft was used in all the patients, one patient underwent previous dilatation at the coarctation level. When present, the ostium of the left subclavian artery was always covered (N=3). RESULTS: No major complication occurred during the procedure and no patient died during the follow-up. One patient presented a type II endoleak which spontaneously healed during the first month. Another patient with his left subclavian artery covered presented claudication of the left arm requiring a carotid-subclavian bypass. After a median follow-up of 7.5 months (range: 1-12.9), the patients were asymptomatic and CT scans demonstrated complete exclusion of all treated postcoarctation aneurysms without recoarctation and without any stent-graft-related complication. CONCLUSIONS: The endovascular management of pseudo-aneurysms after previous surgical repair of congenital aortic coarctation is feasible. This approach was safe and effective. Long-term clinic and imaging follow-up is mandatory.
Authors: Hunaid A Vohra; Allan Odurny; Subhendu Mandal; Nicola Viola; Markku Kaarne; Tony Salmon; Charles Peebles; Marcus P Haw; Gruschen Veldtman Journal: Pediatr Cardiol Date: 2010-02-13 Impact factor: 1.655
Authors: M Rabellino; T Zander; G González; S Baldi; H Cheves; A Estigarribia; R Llorens; J M Carreira; M Maynar Journal: Cardiol Res Pract Date: 2011-04-04 Impact factor: 1.866
Authors: Robert Juszkat; Bartlomiej Perek; Bartosz Zabicki; Olga Trojnarska; Marek Jemielity; Ryszard Staniszewski; Wiesław Smoczyk; Fryderyk Pukacki Journal: PLoS One Date: 2013-12-26 Impact factor: 3.240