An innovative Endovascular Technique for Repair of Descending Thoracic Aortic Aneurysm following an Open Coarctation Repair
Pouria Parsa, MD, Anthony Rios, MD, John Eidt, MD, Javier Vasquez, Jr., MD, Dennis Gable, MD.
Baylor University Medical Center, Dallas, TX, USA.
BACKGROUND: The incidence of aneurysms after surgical treatment of aortic coarctation has been reported to be 11-24%. Aneurysm formation occurs at and around the coarctation site due to the inherent aortic wall medial abnormality secondary to a reduction in smooth muscle cells.
CASE REPORT: Our patient was a 48-year-old male with a significant history of aortic coarctation who had undergone open surgical repair 8 years prior to admission with an aorto-aortic bypass using a 22mm Dacron graft. Patient presents with an aneurysm of the descending aorta (7.5x5.9 cm). Furthermore, ongoing flow in the area of coarctation was detected and was feeding directly into the aneurysm. Intravascular ultrasound (IVUS) was performed to measure the diameter of the coarctation, which was approximately 14mm which was occluded with a a 22mm Amplatzer® plug. IVUS confirmed a 24mm diameter of the vascular graft as measured with Terarecon 3D imaging. We selected a 31 x 15mm Conformable GORE® TAG® Thoracic Endoprosthesis. The graft was then extended down into the mid-descending aorta with a 37 x 15mm GORE® TAG® Thoracic Endoprosthesis. A completion angiogram showed no endoleak into the aneurysmal sac with excellent flow in the supraaortic vessels and distal aortic arch.
CONCLUSIONS - Our case is unique due its combination of the coarctation closure by a vascular plug and the TEVAR treatment of the post-coarctation aneurysm. Endovascular repair of post-coarctation aneurysms is a safe and effective option. The vascular occlusion of the aortic coarctation by a vascular plug seemed to be quite innovative since there is no known reported case of that procedure. The 30-day CT shown in figure 1.0 showed an excellent result and no significant endoleaks were noted.
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