Role of endovascular repair in the management of late pseudo-aneurysms following open surgery for aortic coarctation

• Published in: European journal of cardio-thoracic surgery 2009-10, Vol.36 (4), p.670-674
• Main Authors: Botta, Luca, Russo, Vincenzo, Oppido, Guido, Rosati, Marzia, Massi, Francesco, Lovato, Luigi, Di Bartolomeo, Roberto, Fattori, Rossella
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aneurysm, False - etiology; Aneurysm, False - surgery; Aortic Aneurysm, Thoracic - etiology; Aortic Aneurysm, Thoracic - surgery; Aortic coarctation; Aortic Coarctation - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation - methods; Cardiology. Vascular system; Descending thoracic aorta; Diseases of the aorta; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Endovascular stent-graft repair; Epidemiologic Methods; Female; Humans; Male; Medical sciences; Middle Aged; Minimally Invasive Surgical Procedures - methods; Pneumology; Postoperative Complications - surgery; Pseudo-aneurysm; Stents; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Young Adult
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2009.04.056

Background: Coarctation of the aorta accounts for almost 5% of all congenital cardiac malformations, and it is usually treated by open surgical procedures. Despite the excellent primary results, many patients may develop anastomotic pseudo-aneurysms, associated with considerable morbidity and mortality rates. We investigated the role of endovascular repair as an alternative to open re-do surgery on the descending aorta. Methods: We retrospectively collected data of 11 consecutive patients who presented with pseudo-aneurysms of the descending aorta following previous surgical repair of congenital aortic coarctation. Nine patients developed a pseudo-aneurysm after patch aortoplasty, while an interposition graft repair was performed in two cases. Seven patients underwent an endovascular repair (26.9 years after the previous open surgery). Four patients with a pseudo-aneurysm after coarctation repair associated with arch hypoplasia underwent conventional open re-operation. Results: No complications or death were observed in the conventional surgical group. Technical success was obtained in all patients who received a stent-graft procedure. More than one stent graft was necessary only in one case. A left carotid–left subclavian artery bypass was performed in three patients. Type II endoleak was detected by angiography in one patient who had previously undergone subclavian re-vascularisation. The median follow-up (FU) was 44.5 months and was 100% complete. Neither re-operations nor complications or deaths occurred during FU. Conclusions: Endovascular repair of pseudo-aneurysms following open surgery for aortic coarctation is feasible and safe. However, more patients and longer follow-up are necessary to assess the efficacy of this promising less-invasive alternative to open re-do surgery.