title: Endovascular treatment of late thoracic aortic aneurysms after surgical repair of congenital aortic coarctation in childhood.
abstract: BACKGROUND
  In some patients, local surgery-related complications are diagnosed many years after surgery for aortic coarctation. The purposes of this study were: (1) to systematically evaluate asymptomatic adults after Dacron patch repair in childhood, (2) to estimate the formation rate of secondary thoracic aortic aneurysms (TAAs) and (3) to assess outcomes after intravascular treatment for TAAs.
  
  
  METHODS
  This study involved 37 asymptomatic patients (26 female and 11 male) who underwent surgical repair of aortic coarctation in the childhood. After they had reached adolescence, patients with secondary TAAs were referred to endovascular repair.
  
  
  RESULTS
  Follow-up studies revealed TAA in seven cases (19%) (including six with the gothic type of the aortic arch) and mild recoarctation in other six (16%). Six of the TAA patients were treated with stentgrafts, but one refused to undergo an endovascular procedure. In three cases, stengrafts covered the left subclavian artery (LSA), in another the graft was implanted distally to the LSA. In two individuals, elective hybrid procedures were performed with surgical bypass to the supraaortic arteries followed by stengraft implantation. All subjects survived the secondary procedures. One patient developed type Ia endoleak after stentgraft implantation that was eventually treated with a debranching procedure.
  
  
  CONCLUSIONS
  The long-term course of clinically asymptomatic patients after coarctation patch repair is not uncommonly complicated by formation of TAAs (particularly in individuals with the gothic pattern of the aortic arch) that can be treated effectively with stentgrafts. However, in some patients hybrid procedures may be necessary.
authors.affiliation: Department of Clinical and Interventional Radiology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Juszkat
authors.affiliation: Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Bartlomiej
authors.initials: B
authors.lastname: Perek
authors.affiliation: Department of Clinical and Interventional Radiology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Zabicki
authors.affiliation: Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Olga
authors.initials: O
authors.lastname: Trojnarska
authors.affiliation: Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Jemielity
authors.affiliation: Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Ryszard
authors.initials: R
authors.lastname: Staniszewski
authors.affiliation: Department of Pediatric Radiology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Wiesław
authors.initials: W
authors.lastname: Smoczyk
authors.affiliation: Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Fryderyk
authors.initials: F
authors.lastname: Pukacki
mesh_terms: D000293:Adolescent; D000328:Adult; D000792:Angiography; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D001017:Aortic Coarctation / Q000150:complications* / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D019233:Retreatment; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome