Percutaneous endovascular repair of aneurysm after previous coarctation surgery.
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.


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.
Ince
Hüseyin
H
Division of Cardiology at the University Hospital Rostock, Rostock School of Medicine, Rostock, Germany.
Petzsch
Michael
M
Rehders
Tim
T
Kische
Stephan
S
Körber
Thomas
T
Weber
Frank
F
Nienaber
Christoph A
CA
D000328:Adult; D000368:Aged; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D001017:Aortic Coarctation / Q000150:complications* / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012867:Skin; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome