Endovascular repair of aortic isthmus coarctation with a self-expanding covered stent.
BACKGROUND
Coarctation is one of the most often seen congenital aortal defects. In the majority, diagnosis will be made in newborns. Endovascular repair is critical in children owing to their growth, but in adult patients, it is an interesting alternative.


METHODS
A 31-year-old man presenting with hypertension of upper extremities and pulseless lower extremities was admitted to our hospital. Systolic blood pressure was 190 mm Hg, although a triple antihypertensive medication was administered. Computed tomographic angiography showed a nearly total occlusion of the aortic isthmus. Coarctation was treated by an endovascular approach with a self-expanding covered stent-graft (Medtronic Talent; Medtronic World Medical, Sunrise, FL) after predilatation with a Reliant balloon (Medtronic World Medical, Sunrise, FL).


RESULTS
After a follow-up of 40 months, the patient is normotensive and antihypertensive medication could be reduced. Lower extremities showed normal pulses and normal ankle-brachial index. Computed tomographic scans showed unchanged stent-graft position, with constant slight waist.


CONCLUSIONS
Endovascular repair of atresia or coarctation of the thoracic aorta is a minimal invasive debatable option. Not only reduction of blood pressure but also reduction of left ventricular mass and prolongation of life expectancy can be achieved by endovascular treatment.
Department of Thoracic and Vascular Surgery, University of Ulm, Ulm, Germany. alexander.oberhuber@uniklinik-ulm.de
Alexander
A
Oberhuber
Bernd M
BM
Muehling
Karl-Heinz
KH
Orend
Hubert
H
Schelzig
D000328:Adult; D000792:Angiography; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D020099:Coated Materials, Biocompatible; D057510:Endovascular Procedures / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D015607:Stents; D014057:Tomography, X-Ray Computed
D020099:Coated Materials, Biocompatible