Society For Clinical Vascular Surgery

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Symptomatic Coarctation of Aorta (COA) and Saccular Aneurysms of Distal Aortic Arch and Proximal Descending Aorta: Case Report
Simpledeep Banipal, MD, Yevgeniy Rits, MD, Jeffery Rubin, MD.
Wayne State University/Detroit Medical Center, Detroit, MI, USA.

OBJECTIVES: Coarctation of aorta (COA) is defined as the hemodynamically significant narrowing of the descending thoracic aorta. COA accounts for 6.5% of all congenital heart defects. Aneurysm of the descending aorta associated with COA is a rare congenital abnormality. We present a case report of 14 year old female with COA and saccular aneurysms of distal aortic arch and proximal descending aorta treated with left common carotid artery (CCA) to subclavian (SC) artery bypass and stent implantation.
METHODS: Case report.
RESULTS: Patient is a 14 year old female with history of growth hormone deficiency and known mild COA and saccular aneurysms of distal aortic arch and proximal descending aorta who was initially treated conservatively. Over last three years, she had developed hypertension (requiring to be on Lisinopril) with 20 mm Hg pressure gradient across the COA and the saccular aneurysms were enlarging (from 19 mm diameter to 27 mm). The involved segment of aorta measured about 4 cm in length, starting about 1 cm distal to the origin of the left CCA and extending distally involving the origin of left SC artery (Figure 1A). She was taken to the operating room and a left CCA to SC artery bypass with 6 mm PTFE was performed first. There was foreshortening of the 21 mm x 10 cm Gore TAG grafts upon balloon inflation. Therefore, a 39 mm Covered Cheatham-Platinum (CCP) stent was mounted on a NuMed Z-Med II balloon 20 mm x 4 cm and deployed by inflating to 16 mm (Figure 1B and 1C). After the stent repair the pressure gradient between the ascending and descending aorta was 5 mm Hg. The patient had an uneventful recovery and was discharged home. Patient has had resolution of her hypertension and is off Lisinopril.
CONCLUSIONS: In summary, we present a case report of rare saccular aneurysms associated with COA segment in a young patient treated with hybrid approach involving left common CCA to left SC artery bypass and stent implantation.

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