Aortic aneurysms at the site of the repair of coarctation of the aorta: A review of 48 patients

Percutaneous Endovascular Repair of Aneurysm After Previous Coarctation Surgery

“…12,16 Reoperation after previous patch-graft aortoplasty carries a 14% mortality rate and significant morbidity, including paralysis of the nervus recurrens and bleeding complications 3,17 ; similarly, Kieffer et al 18 found that open surgery for thoracic aneurysm in association with aberrant subclavian arteries is associated with a 23.5% mortality rate and a 13% paraplegia rate. Yet, conservative treatment of aneurysm after surgical coarctation repair remains unpredictable and is associated with a 100% rate of rupture within 15 years in the single-center experience of Knyshov et al 3 Our preliminary series demonstrates promising potential of endovascular stent-graft treatment in 6 patients with late aneurysm formation after complex surgical repair of coarctation ( Figure 2, A and B). Transfemoral stent-graft deployment was safe and completed within 54Ϯ19 minutes in a multidisciplinary effort of an interventional cardiologist, a vascular surgeon for open femoral access, and anesthesiologist and led to favorable intrainterventional and postinterventional outcomes.…”

“…Our encouraging results in 6 consecutive patients undergoing endovascular repair for post-patch-graft aortoplasty aneurysm suggest potential for a new nonsurgical option. 3,11,16 The problem of postsurgical aneurysm formation has also been recognized after bypass grafting for long aortic coarctation and even after subclavian flap aortoplasty. 12,16 Reoperation after previous patch-graft aortoplasty carries a 14% mortality rate and significant morbidity, including paralysis of the nervus recurrens and bleeding complications 3,17 ; similarly, Kieffer et al 18 found that open surgery for thoracic aneurysm in association with aberrant subclavian arteries is associated with a 23.5% mortality rate and a 13% paraplegia rate.…”

“…3,11,16 The problem of postsurgical aneurysm formation has also been recognized after bypass grafting for long aortic coarctation and even after subclavian flap aortoplasty. 12,16 Reoperation after previous patch-graft aortoplasty carries a 14% mortality rate and significant morbidity, including paralysis of the nervus recurrens and bleeding complications 3,17 ; similarly, Kieffer et al 18 found that open surgery for thoracic aneurysm in association with aberrant subclavian arteries is associated with a 23.5% mortality rate and a 13% paraplegia rate. Yet, conservative treatment of aneurysm after surgical coarctation repair remains unpredictable and is associated with a 100% rate of rupture within 15 years in the single-center experience of Knyshov et al 3 Our preliminary series demonstrates promising potential of endovascular stent-graft treatment in 6 patients with late aneurysm formation after complex surgical repair of coarctation ( Figure 2, A and B).…”

“…1 Postsurgical aneurysm formation is observed with subclavian flap angioplasty in 17%, after patch angioplasty in 14%, after interposition graft repair in 6%, and occasionally with end-to-end anastomosis in the presence of persistent systemic hypertension or after the use of Dacron sutures 2 ; postsurgical aortic aneurysm may present as false, true, or dissecting. 3 Balloonexpandable endovascular stents have been used successfully as primary treatment for coarctation and recoarctation. 4,5 The concept of endovascular stent-grafts for secondary repair of postsurgical aneurysm, however, has not been tested.…”

Endovascular Covered Stent Treatment for Descending Aorta Pseudoaneurysm Following Coarctation of the Aorta Repair in an Infant

“…Re-do surgery for aortic pseudoaneurysms is associated with high morbidity (paraplegia, recurrent laryngeal nerve paralysis, phrenic nerve injury) and mortality [6,7]. Conservative management is associated with a high rate of rupture and death [8].…”