New-generation stent grafts for endovascular management of thoracic pseudoaneurysms after aortic coarctation repair.
OBJECTIVE
Late thoracic aneurysms develop in 5% to 12% of patients having undergone open repair for coarctation of the aorta (CoA). We report our early results for thoracic endovascular aortic repair for pseudoaneurysms after CoA repair.


METHODS
From 2008 to 2013, data regarding demographics, aneurysm morphology, procedure, and follow-up were collected prospectively on all patients treated for pseudoaneurysms after CoA repair. Retrospective analysis of identified patients was then performed.


RESULTS
Thirteen patients (six men, seven women) were treated. Patients were a median age, 45 years (interquartile range (IQR), 39-56; range, 27-66 years, and the median time after CoA repair to aneurysm treatment was 34 years (IQR, 24-40 years). All patients had saccular pseudoaneurysms of the aortic arch, with a median aneurysm size of 4.1 cm (IQR, 3.4-5.1 cm). The left subclavian artery (LSCA) was involved in 10 patients and was occluded at presentation in three. Four patients had concurrent LSCA revascularization with carotid-subclavian bypass, one had aortic arch hybrid repair, and the LSCA was intentionally covered in two patients. Patients underwent thoracic endovascular aortic repair using the conformable TAG (6 of 13; W. L. Gore & Associates, Flagstaff, Ariz), Valiant device (4 of 13; Medtronic, Minneapolis, Minn), and a custom-made Relay endograft with LSCA scallop (4 of 13; Bolton Medical, Barcelona, Spain). Technical success was 100%, with satisfactory deployment of the stent grafts in all patients. There was no 30-day mortality, stroke, or paraplegia. Median follow-up was 15 months (IQR, 9-19 months; range, 1-67 months). Two type II endoleaks from an intercostal artery were managed conservatively, and one type Ib endoleak was treated successfully with distal stent extension.


CONCLUSIONS
In this cohort, new-generation stent grafts have good early clinical and radiologic outcomes, avoiding the need for redo open surgery. Management of the LSCA can be tailored to individual patients with new stent graft technology. Long-term follow-up of these patients is crucial to understanding whether endovascular management of this cohort is acceptable.
Imperial Vascular Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Surgery, Imperial College London, London, United Kingdom.
Anisha H
AH
Perera
Imperial Vascular Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Surgery, Imperial College London, London, United Kingdom.
Nung
N
Rudarakanchana
Department of Surgery, Imperial College London, London, United Kingdom; Department of Interventional Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
Mohamad
M
Hamady
Department of Interventional Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
Elika
E
Kashef
Imperial Vascular Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
Maziar
M
Mireskandari
Adult Congenital Heart Disease Centre, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
Anselm
A
Uebing
Imperial Vascular Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Surgery, Imperial College London, London, United Kingdom.
Nicholas J
NJ
Cheshire
Imperial Vascular Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Surgery, Imperial College London, London, United Kingdom. Electronic address: colin.bicknell@imperial.ac.uk.
Colin D
CD
Bicknell
D000328:Adult; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001017:Aortic Coarctation / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D057867:Endoleak / Q000209:etiology / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome