Hybrid Surgical Approach to a Giant Post-Coarctation Aortic Aneurysm. (December 2021)

• Record Type: Journal Article
• Authors: Di Domenico, Rossella; Fargion, Aaron Thomas; Speziali, Sara; Petroni, Rachele; Villani, Flavio; Esposito, Davide; Pratesi, Carlo
• Is Part Of: Journal of endovascular therapy. Volume 28:Number 6(2021)
• Page Start: 961
• Page End: 964
• Publication Date: 2021-12
• Subjects: coarctation -- thoracoabdominal aneurysm -- dissection -- hybrid repair -- visceral arteries; Blood-vessels -- Endoscopic surgery -- Periodicals; Angioscopy -- Periodicals; Intravenous catheterization -- Periodicals; Peripheral vascular diseases -- Treatment -- Periodicals; Vascular Surgical Procedures -- Periodicals; Angioscopy -- Periodicals; Catheterization, Peripheral -- Periodicals; Peripheral Vascular Diseases -- therapy -- Periodicals; Angioscopie; Maladies vasculaires périphériques; 617.413
• DOI: 10.1177/15266028211032954
• Languages: English
• ISSNs: 1526-6028

Abstract

Purpose: To report a rare case of giant aortic coarctation (CoA)-related descending thoracic aneurysmal degeneration, complicated by an acute aortic dissection. Case Report: A 57-year-old man referred with acute chest pain to the emergency department. A computed tomography angiography (CTA) revealed a CoA with a giant post-stenotic descending thoracic aneurysm (14 cm) and a concomitant left subclavian artery (LSA) aneurysm, complicated by an acute type B aortic dissection. A single-stage hybrid procedure was planned in an urgent setting. Initially, a left common carotid-to-left subclavian artery (LCCA-LSA) bypass was performed to gain a suitable proximal landing zone, the procedure was then completed with 3 thoracic endografts and 1 aortic dissection stent through a percutaneous femoral approach. The patient was discharged in postoperative day 8th without complications; the CTA performed at 1 month demonstrated patency of supra-aortic and visceral vessels, dilation of CoA site and exclusion of the false lumen. Conclusions: CoA is a congenital malformation rarely found in adults that may represent a challenge for the surgeon, especially when combined with a complication like an acute aortic dissection. This case shows that a hybrid approach is a safe and feasible treatment option even in such complex anatomies.