Dissection of thoraco-abdominal aorta following stenting for coarctation

Abstract

Endovascular stenting is commonly employed for coarctation of the aorta [1][2][3]. Complications following this procedure include stent migration and dissection of the aorta [4,5]. We report on one such case with extensive dissection of the aorta following stenting and its successful surgical management.A 21 year old male patient presented to us with a diagnosis of severe post-ductal coarctation of aorta, and underwent dilatation and stenting of the coarctation. Two Advanta TM V12 LD stents [Atrium Medical Inc, USA] were placed across the coarctation. The second stent however migrated distally resulting in dissection of the thoraco-abdominal aorta extending upto the level of the common iliac arteries (Figs. 1 (a) and (b), 2 and 3). He underwent emergency stent removal and repair of aortic dissection.At surgery he was placed on single right lung ventilation and femoro-femoral cardiopulmonary bypass was established. The descending aorta was approached through a left postero-lateral thoracotomy. The position of the stent was confirmed by palpating of the aorta. Aorta was found to be inflamed. The patient was cooled down to 18°C and circulatory arrest was established.The aorta was opened longitudinally (Fig. 4), the stent removed and a single entry point of dissection on the posterior aspect of aorta was closed by pledgetted nonabsorbable sutures. The aorta was closed using a Polytetrafluoroethylene (PTFE) patch. The first stent Fig. 1 a Axial CECT image at the level of T 5 ,T 6 vertebra showing cranial stent lying in the descending aorta (arrow). b CT image at a slightly lower level showing thin intimal flap separating the true and false lumen of the dissection. Beak sign (arrow) is seen in the false lumen