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OBJECTIVES:
Patients with aortic coarctation diagnosed at a young age often undergo surgical repair. Recurrence of aortic coarctation in adults presents with exercise intolerance, hypertension, and or claudication. We present our experience with the use of endovascular techniques for the treatment of recurrent aortic coarctation.
Methods:
Three patients with recurrent aortic coarctation after surgical repair presented with hypertension (2), claudication (1) and aneurysm formation (1). The original repair had been performed 8 to 16 years prior to presentation. In one patient the initial recurrence was treated with a left ventricle to descending thoracic aortic bypass which failed four years later.
Results:
The recurrent coarctation was treated in two patients with a combined endovascular and surgical repair. Both patients required a Palmaz stent within the endograft at the stenotic segment in addition to the endovascular graft. In both patients, there was resolution of the pressure gradient. Temporary hypotension by the administration of adenosine or rapid ventricular pacing was used in both cases during deployment of the Palmaz stents. The third patient had endovascular repair of an aneurysm with an endovascular graft across the previous repair. There was no mortality. All patients remain asymptomatic on follow-up (16 months to 48 months).
CONCLUSIONS:
Recurrent stenosis after aortic coarctation repair can be a challenging problem. Endovascular technology can be applied to the treatment of recurrent aortic coarctation reducing the risk of re-intervention. Resolution of a pressure gradient may require additional radial force using a balloon expandable stent.