Combined surgical and endovascular approach to treat a complex aortic coarctation without extracorporeal circulation.
Various therapeutic approaches have been proposed to treat complex coarctation of the aorta (eg, recoarctation, which requires repetitive interventions, or coarctation with a hypoplastic aortic arch). Resection followed by end-to-end anastomosis or by graft interposition is technically demanding and exposes the patient to considerable perioperative risks. Cardiopulmonary bypass and deep hypothermic circulatory arrest may be necessary to control the distal aortic arch. The role of stent technology in treating this type of lesion has not yet been defined. We present a 21-year-old woman with a recurrent coarctation of the aorta associated with a hypoplastic aortic arch and a pseudoaneurysm of the proximal descending aorta. She had undergone 4 previous interventions. Treatment consisted of a combined surgical and endovascular approach without cardiopulmonary bypass and included extraanatomic aortic bypass, partial debranching of the supraaortic vessels, and stent-graft insertion to exclude the aneurysm.
Carrel
Thierry P
TP
Clinic for Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland. thierry.carrel@insel.ch
Berdat
Pascal A
PA
Baumgartner
Iris
I
Dinkel
Hans-Peter
HP
Schmidli
Jürg
J
D000328:Adult; D000714:Anastomosis, Surgical; D017541:Aneurysm, False / Q000150:complications / Q000601:surgery; D015906:Angioplasty, Balloon, Coronary; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001011:Aorta / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery; D001017:Aortic Coarctation / Q000150:complications / Q000601:surgery*; D001018:Aortic Diseases / Q000150:complications / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D002339:Carotid Arteries / Q000601:surgery; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D015607:Stents; D013348:Subclavian Artery / Q000601:surgery; D018084:Ultrasonography, Interventional
D000959:Antihypertensive Agents