Percutaneous endovascular repair of aneurysm after previous coarctation surgery

Circulation. 2003 Dec 16;108(24):2967-70. doi: 10.1161/01.CIR.0000106902.51626.AF. Epub 2003 Dec 8.

Abstract

Background: Formation of aortic aneurysm late after surgical repair of coarctation carries a significant risk of rupture and lethal outcome, and repeat surgery is associated with a 14% in-hospital mortality rate and morbidity from paraplegia, injury to the central nervous system, or from bleeding. The potential of nonsurgical endovascular repair by the use of stent-grafts in lieu of repeat surgery for postcoarctation aneurysm is unknown.

Methods and results: The concept of postsurgical endovascular stent-graft placement was evaluated with respect to feasibility and safety in 6 consecutive patients with late aneurysm formation after coarctation repair. All patients had aneurysm formation late after patch aortoplasty; placement of an elephant trunk during surgical repair of secondary type I dissection preceded formation of a local aneurysm in 2 cases. Patient age was 49+/-12 years, ranging from 31 to 68 years. Transluminal placement of customized stent-grafts was successful, with no 30-day or 1-year intervention-related mortality or morbidity. Follow-up survey of 11 to 47 months revealed optimal reconstruction of the thoracic aorta; 1 patient died 11 months after endovascular repair from cancer.

Conclusions: Nonsurgical aortic reconstruction of postsurgical thoracic aneurysms forming late after coarctation repair is safe and feasible; interventional stent-graft placement has the potential to avoid repeat surgery of postsurgical aortic aneurysm.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Aortic Aneurysm / diagnosis
  • Aortic Aneurysm / etiology
  • Aortic Aneurysm / surgery
  • Aortic Aneurysm / therapy*
  • Aortic Coarctation / complications*
  • Aortic Coarctation / surgery
  • Blood Vessel Prosthesis* / adverse effects
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Angiography
  • Male
  • Middle Aged
  • Skin
  • Stents* / adverse effects
  • Treatment Outcome