Thoracic Endovascular Aortic Repair For Treatment Of Distal Aortic Arch Dissected Aneurysm Associated With Coarctation.
Giuseppe Comentale1, Fabio Scigliano1, Rosa Alba Mozzillo1, Gaetano Castellano2, Luigi Di Tommaso1, Gabriele Iannelli1.
1Department of Cardiac Surgery A.O.U. Federico II, Napoli, Italy, 2Department of Anesthesiology A.O.U. Federico II, Napoli, Italy.
Objective: Late aneurysm formation of the proximal aorta or distal aortic arch is a well recognized complication of untreated aortic isthmus stenosis and is associated with a significant risk of aortic rupture. Late aneurysm formation may occur at the site of repair as a complication resulting from any type of surgical technique for coarctation repair.
Here we describe a case of a young man, a Jehovah’s Witness, with an untreated coarctation of the aorta and a dissected pre-stenotic thoracic aortic aneurysm, treated in emergency with thoracic endovascular aortic repair (TEVAR).
A 44 years-old man, with an untreated aortic coarctation was admitted in emergency with a diagnosis of ruptured thoracic aortic aneurysm. The patient knew he had an aortic coarctation complicated with a large prestonotic aortic aneurysm, but has been refused for conventional surgery because he was a Jehovah witness. Computer tomography showed a voluminous fissured aneurysm of the descending thoracic aorta. The patient was not suitable for conventional surgery for the risk of bleeding and blood transfusions. Endovascular surgery appears to be a safe alternative.
Methods: The procedure was performed in an hybrid operating room under general. Femoral access was achieved by surgical dissection of the right femoral artery. Several attemps to cross coarctation and tortuous aorta with a guide wire from the femoral artery had failed. A stiff guide wire was inserted from right radial artery up to the common right femoral artery to backward introduce a pigtail catheter with “cable-car system”. The aorta was straightened with two extra stiff guide wires..Two Medtronic-Valiant stent-grafts were deployed at level of distal aortic arch over one of the extra stiff guide wires. We deliberately covered the left subclavian artery. The patient was discharged from the hospital within one week.
Results: Follow-up CT scan was performed at 3,6, 18 and 36 months. Complete thrombosis of the aneurysmal sac was achieved. The patient does not report any symptoms related to the intentional occlusion of the LSA.
Conclusions: Our encouraging experience suggests that endoluminal repair is a useful alternative treatment to open surgical operation for aneurysms associated with coarctation of the aorta.
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