Endovascular repair of pseudoaneurysms after open surgery for aortic coarctation.
OBJECTIVE
To analyse early and long-term results of thoracic endovascular aortic repair (TEVAR) in patients with pseudoaneurysms after open aortic coarctation (CoA) repair.


METHODS
A total of 11 patients of 418 patients who had been treated with TEVAR during the period from January 1998 to April 2015 (8 males; median age 53 years) were retrospectively analysed. Dacron patch aortoplasty was primarily performed in 9 patients and subclavian flap aortoplasty in 2 patients. Seven of the 11 patients had asymptomatic pseudoaneurysms (median diameter 56 mm, range 20-65 mm) diagnosed by routine screening. Symptomatic patients presented with haemoptysis, lower limb ischaemia, haemodynamic collapse and back pain and underwent emergency repair (4/11). Adjunctive procedures at the proximal landing zone were required in 7/11 patients. The median number of implanted endoprostheses per patient was 1 (range: 1-5). The median follow-up was 60 months (range 6-161 months).


RESULTS
Technical success was achieved in 91% (10/11; 1 secondary elective open conversion). The 30-day mortality was 0%. The stroke rate was 18% (2 non-disabling strokes). In 2 patients (20%), stent-graft displacement during deployment was observed. The reintervention rate was 33% (Type Ib endoleak, left arm claudication, partial coverage of the left common carotid artery). Clinical success during follow-up was achieved in 10/11 patients. In 9/10 patients, aneurysm sac shrinkage was observed. The Type II endoleak rate was 10% (1/10; intercostal artery). The overall mortality rate was 9% (1 patient died of amyotrophic lateral sclerosis).


CONCLUSIONS
Endovascular treatment of post-coarctation pseudoaneurysms is feasible in elective and emergency cases, yielding durable results in the long term. Due to anatomical specifics, implantation may be challenging and requires careful procedural planning. On-site cardiothoracic surgery backup is essential in case open conversion is required.
Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Drosos
D
Kotelis
Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Moritz S
MS
Bischoff
Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany.
Fabian
F
Rengier
Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Arjang
A
Ruhparwar
Department of Pediatric Cardiology and Congenital Heart Diseases, Heidelberg University Hospital, Heidelberg, Germany.
Matthias
M
Gorenflo
Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany dkotelis@hotmail.com.
Dittmar
D
Böckler
D000293:Adolescent; D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001017:Aortic Coarctation / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
Aorta; Aortic coarctation; Pseudoaneurysm; TEVAR; Thoracic endovascular aortic repair