Endoluminal stent-graft repair in a patient with coarctation of the aorta and previous iatrogenic type B aortic dissection and expanding pseudoaneurysm.
OBJECTIVE
To report endoluminal repair of aortic coarctation in a patient with a chronic type B aortic dissection presenting with an expanding pseudoaneurysm after failure of surgical repair.


METHODS
This 30-year-old man with a congenital coarctation of the aorta suffered an iatrogenic type B aortic dissection during angiography at the age of 6. Emergent surgery at that time included a left subclavian artery-to-distal thoracic aorta surgical conduit; the coarctation itself was not repaired. The patient presented 24 years after the surgery with a chronic distal extension of the dissection and a pseudoaneurysm severely compressing the aortic true lumen; the disrupted surgical conduit drained into the false lumen. In a novel approach, the true aortic lumen was intentionally occluded, and the surgical conduit was secured with stent-grafts to successfully exclude the pseudoaneurysm from the circulation.


CONCLUSIONS
Type B dissection and coarctation of the aorta, in the setting of complex aortic pathology and comorbidities, can be treated with an endovascular approach.
Department of Cardiology, Texas Heart Institute, and St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
Lawrence
L
Rajan
Kathryn
K
Dougherty
Zvonimir
Z
Krajcer
D000328:Adult; D000784:Aortic Dissection / Q000145:classification / Q000150:complications*; D017541:Aneurysm, False / Q000150:complications*; D017130:Angioplasty; D017545:Aortic Aneurysm, Thoracic / Q000150:complications*; D001017:Aortic Coarctation / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D015607:Stents