Endovascular management of pseudo-aneurysms after previous surgical repair of congenital aortic coarctation.
OBJECTIVE
Whatever the surgical technique used, false aneurysm formation is one of the long-term complications of repair of aortic coarctation. Conservative management is associated with a 100% rate of rupture. The conventional surgical approach is complex and associated with high morbidity and mortality rates. We report our experience of endovascular management of pseudo-aneurysms after previous surgical repair of congenital aortic coarctation.


METHODS
Between October 2005 and 2006, stent-grafting of pseudo-aneurysms after previous surgical repair of congenital aortic coarctation was performed in four patients. Median age was 31.5 years (range: 24-38). Two patients had undergone two previous interventions. The last previous surgery consisted of graft interposition (N=2), subclavian flap aortoplasty (N=1) and aorto-aortic bypass (N=1). Median size of the pseudo-aneurysm was 31.5mm (range: 20-58). Mean time between the last surgery and endovascular treatment was 24 years (range: 3-32). One patient was treated emergently because of hemoptysis in relation with an aorto-bronchial fistula, the three other patients were treated electively. A transfemoral approach was used in all patients. The Zenith TX2 (Cook) thoracic stent-graft was used in all the patients, one patient underwent previous dilatation at the coarctation level. When present, the ostium of the left subclavian artery was always covered (N=3).


RESULTS
No major complication occurred during the procedure and no patient died during the follow-up. One patient presented a type II endoleak which spontaneously healed during the first month. Another patient with his left subclavian artery covered presented claudication of the left arm requiring a carotid-subclavian bypass. After a median follow-up of 7.5 months (range: 1-12.9), the patients were asymptomatic and CT scans demonstrated complete exclusion of all treated postcoarctation aneurysms without recoarctation and without any stent-graft-related complication.


CONCLUSIONS
The endovascular management of pseudo-aneurysms after previous surgical repair of congenital aortic coarctation is feasible. This approach was safe and effective. Long-term clinic and imaging follow-up is mandatory.
Marcheix
Bertrand
B
Department of Cardiovascular Surgery, Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec, Canada.
Lamarche
Yoan
Y
Perrault
Pierre
P
Cartier
Raymond
R
Bouchard
Denis
D
Carrier
Michel
M
Perrault
Louis P
LP
Demers
Philippe
P
D000328:Adult; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001011:Aorta / Q000601:surgery; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001017:Aortic Coarctation / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012086:Reoperation; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome