title: Endovascular repair of aortic coarctation pseudoaneurysm using an off-label "hourglass" stent-graft configuration.
abstract: OBJECTIVE
  To describe an endovascular technique for treating a pseudoaneurysm of the thoracic aorta using an off-label "hourglass" stent-graft configuration.
  
  
  METHODS
  A 68-year-old patient with prior open thoracic aorta coarctation repair presented with recurrent coarctation and concurrent enlarging 6-cm bilobed pseudoaneurysm involving the previous anastomosis. There was significant discrepancy in the aortic diameter (measured from wall to wall) proximal to the coarctation (14 mm), at the narrowest segment (8 mm), and distally (23 mm). Endovascular repair included deployment of an inverted iliac limb proximally, followed by an inverted aortic converter distally, giving an "hourglass" configuration. There were no perioperative or stent-graft-related complications at 5-year follow-up. The aneurysm regressed from 61 to 25 mm.
  
  
  CONCLUSIONS
  The use of inverted stent-grafts can allow tapering and flaring to adapt to discrepant aortic diameters. This technique may be useful in select patients with prior coarctation repair who do not need excessive dilation of the narrow aortic segment.
authors: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Young
authors: Y
authors: Erben
authors: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA oderich.gustavo@mayo.edu.
authors: Gustavo S
authors: GS
authors: Oderich
authors: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Audra A
authors: AA
authors: Duncan
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D001017:Aortic Coarctation / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D011474:Prosthesis Design; D012008:Recurrence; D012086:Reoperation; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: coarctation; endovascular repair; iliac limb stent-graft; physician-modified device; pseudoaneurysm; recurrent coarctation; reversed stent-graft; stent-graft