Endovascular approaches for complex forms of recurrent aortic coarctation.
OBJECTIVE
To review a single-center experience with endovascular treatment of recurrent aortic coarctation in adults.


METHODS
Since 1998, 11 patients (9 men; mean age 48+/-15 years, range 16-63) with recurrent aortic coarctation following previous coarctation repair were referred to our institution for treatment. Clinical presentations included pseudoaneurysm (n=2), restenosis (n=3), pseudoaneurysm accompanied by restenosis (n=4), and rupture of a post-coarctation pseudoaneurysm (n=2). All patients were treated using an endovascular approach as part of a single-center investigational device exemption protocol.


RESULTS
Endovascular interventions included Palmaz stent implantation (n=3), implantation of an endoluminal graft (n=2), or a combination of both treatments in 6 patients. Three patients underwent balloon angioplasty before stenting or endografting, and 2 patients had a carotid-subclavian bypass done before the endovascular repair. All repairs were technically and clinically successful. The median length of stay after repair was 2.0+/-2.3 days. In follow-up, 2 patients underwent a carotid-subclavian bypass for left upper extremity claudication. Two patients required reintervention owing to migration of the stent in 1 and an endoleak 2 years after the initial procedure in the other.


CONCLUSIONS
Endovascular approaches to adult coarctation appear to be safe and effective. With the emergence of endoluminal grafts and the widespread availability of the Palmaz stent, endovascular repair offers an excellent alternative to open surgery for complex cases of recurrent coarctation. Additional studies are indicated to assess the long-term outcomes of these patients.
Preventza
Ourania
O
Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute and Arizona Heart Hospital, Phoenix, Arizona, USA.
Wheatley
Grayson H
GH
Williams
James
J
Hughes
Kakra
K
Ramaiah
Venkatesh G
VG
Rodriguez-Lopez
Julio A
JA
Diethrich
Edward B
EB
D000293:Adolescent; D000328:Adult; D000800:Angioplasty, Balloon; D001017:Aortic Coarctation / Q000517:prevention & control / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055502:Secondary Prevention; D015607:Stents; D016896:Treatment Outcome