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.
Rajan
Lawrence
L
Department of Cardiology, Texas Heart Institute, and St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
Dougherty
Kathryn
K
Krajcer
Zvonimir
Z
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