title: Coarctation-associated aneurysms: a localized disease or diffuse aortopathy.
abstract: BACKGROUND
  We evaluated the occurrence and treatment of aortic aneurysms in coarctation patients.
  
  
  METHODS
  During 1962 to 2011, 943 cases of coarctation were repaired. Aortic aneurysms were identified in 55 patients (5.8%). Forty-eight had prior coarctation repair (median 23 years earlier, interquartile range 18 to 26 years). Forty-two aneurysms were found in the descending thoracic aorta (76.4%), 18 in the ascending aorta (32.7%), 8 in the left subclavian artery (14.5%), and 1 each (1.8%) in the abdominal aorta, iliac artery, and innominate artery. Twenty-three patients (41.8%) had multiple aneurysms. Twenty-five patients (45.4%) had a bicuspid aortic valve.
  
  
  RESULTS
  Fifty-three patients' aneurysms were treated surgically. Thirty-five (66.0%) had descending thoracic aortic repair, of whom 11 had aorto-left subclavian bypass. Aortic cross-clamping alone was used in 23 patients, left heart bypass in 4, and circulatory arrest in 8. Eleven patients underwent endovascular repair (20.8%). Proximal aortic aneurysms were repaired in 7 patients (13.2%); 1 had simultaneous antegrade endostent delivery. Four patients had ascending-to-descending aortic bypass (7.3%). Concomitant valve-sparing root repair was performed in 2 patients, Bentall in 4, aortic valve replacement in 3, and coronary artery bypass in 1. One 30-day death occurred (1.9%). Three patients (5.7%) had transient neurologic deficits, 2 (3.8%) required tracheostomy, and 11 (20.8%) had vocal cord paralysis.
  
  
  CONCLUSIONS
  Coarctation is a marker for aortic aneurysm formation in adults and merits long-term surveillance. Anatomic complexity and associated conditions can complicate the surgical repair. Various open, extra-anatomic, and endovascular techniques may be used.
authors: Department of Cardiovascular Surgery, The Texas Heart Institute at St. Luke's Episcopal Hospital/Baylor College of Medicine, Houston, Texas, USA.
authors: Ourania
authors: O
authors: Preventza
authors: James J
authors: JJ
authors: Livesay
authors: Denton A
authors: DA
authors: Cooley
authors: Zvonimir
authors: Z
authors: Krajcer
authors: Benjamin Y
authors: BY
authors: Cheong
authors: Joseph S
authors: JS
authors: Coselli
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002648:Child; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods; D055815:Young Adult