[Occlusive aortic disease as coral reef aorta--experience in 80 cases].
BACKGROUND
Coral reef aorta (CRA) is described as rock-hard calcifications in the visceral part of the aorta. These heavily calcified plaques grow into the lumen and can cause significant stenoses, leading to malperfusion of the lower limbs, visceral ischaemia or hypertension due to renal ischaemia.


METHODS
From 1/1984 to 11/2008, 80 patients (26 m, 54 f, mean age 61.6, range 14 to 86 years) underwent treatment in the Department of Vascular Surgery and Kidney Transplantation, Heinrich-Heine-University Hospital for CRA. The present study is based on a review of patient records and prospective follow-up in our outpatient clinic.


RESULTS
The most frequent finding was renovascular hypertension (n=33, 41.3%) causing headache, vertigo and visual symptoms. Intermittent claudication due to peripheral arterial occlusive disease was found in 35 cases (43.8%). 15 patients (18.8%) presented with chronic visceral ischaemia causing diarrhoea, weight loss and abdominal pain. 79 patients (98.7%) underwent surgery; in 73 (93.7%) aortic reconstruction was achieved with thromboendarterectomy, on an isolated suprarenal segment in 7 (9.3%), an infrarenal segment in 21 (26.6%), and the supra- and infrarenal aorta in 45 cases (60%). Desobliteration of renal arteries was performed in 47 (one-sided n=8, 10.1%; both arteries n=39, 49.4%); the aortic bifurcation was desobliterated in 37 (46.8%), extension into iliac arteries was necessary in 29 cases (one-sided n=4, 5.1%; both arteries n=25, 31.6%). The coeliac trunk was desobliterated in 43% (n=34), the superior mesenteric artery in 44.3% (n=35) and the inferior mesenteric artery in 20.3% (n=16). In 15 cases additional revascularisation (bypass, transposition, graft interposition) was necessary. Surgical access was via a left-sided thoracoabdominal incision in 56.4% (n=45) and via laparotomy in 41.8% (n=33). The 30-day lethality was 8.7% (n=7). Postoperative complications requiring corrective surgery occurred in 11 patients (13.9%). Almost ⅓ of the patients (n=19, 27.5%) returned for follow-up after a mean of 52.6 months (range 3 to 215 months). Of these, there was significant clinical and diagnostic improvement in 16 (84.2%) and 3 (15.8%) were unchanged. Impairment was not observed.


CONCLUSIONS
In spite of the existing and improving surgical techniques for the treatment of CRA, procedures are challenging and should be performed in centres with expertise.
Sagban
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AT
Universitätsklinik Düsseldorf, Klinik für Gefäßchirurgie und Nierentransplantation, Düsseldorf, Deutschland. drsagban@yahoo.de
Grotemeyer
D
D
Rehbein
H
H
Sandmann
W
W
Duran
M
M
Balzer
K M
KM
Grabitz
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000601:surgery*; D001018:Aortic Diseases / Q000175:diagnosis / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000601:surgery*; D017073:Atherectomy; D019917:Blood Vessel Prosthesis Implantation; D002114:Calcinosis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006978:Hypertension, Renovascular / Q000175:diagnosis / Q000601:surgery; D007511:Ischemia / Q000000981:diagnostic imaging / Q000601:surgery; D007668:Kidney / Q000098:blood supply; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011859:Radiography; D012189:Retrospective Studies; D015996:Survival Rate; D017131:Thrombectomy; D014781:Viscera / Q000098:blood supply; D055815:Young Adult