Single-stage endovascular management of complicated thoracic aorta coarctation concurrent with aortic arch aneurysm using a novel fenestration device

Abstract

To present a case with aorta coarctation complicated by aortic arch aneurysm which is clinical rare and entails a high risk of rupture. Here we reported a 46-year-old female patient diagnosed with aortic arch aneurysm combined with coarctation. The computed tomography angiography shows that an irregular aneurysm was located at the aortic arch site with its maximal diameter 86.55 mm and the right end of aneurysm was located 10 mm away from the ostium of left common carotid artery (LCCA). The aneurysm body invaded the left subclavian artery, and at the distal end of aneurysm a coarctation had been observed with a minimum diameter reaching 2.7 mm. We performed percutaneous balloon angioplasty, thoracic endovascular aortic repair to exclude the aneurysm, and simultaneously used a novel in situ fenestration device (Quick-Fenestrater) to revascularize the covered LCCA. This is first case of using a novel fenestration device single-stage endovascular treatment of complicated thoracic aorta coarctation concurrent with aortic arch aneurysm. Combined endovascular techniques can elevate the success rate of reconstruct complicated aorta aneurysm concurrent with coarctation and reduce complications. Under the guidance of QuickFenestrater, in situ fenestration could be performed with safety and a high success frequency.

Saccular “Cauliflower” aneurysm of coarctation of aorta: a hybrid management

“…Another case reported a 46-year-old man with coarctation of aorta concurrent with aortic arch aneurysm invading the left subclavian artery in whom a novel fenestration device was utilised to create fenestration of left common carotid artery. 4 There are few other cases of this approach in the literature; however, they were all in adults with significant co-morbidities who were considered high-risk surgical patients. 8,9 In our case, the use of covered balloon or self-expanding stents would have jailed off the subclavian artery.…”

“…2 Presence of aneurysm in patients with coarctation of the aorta has management challenges and poses high risk of aortic rupture. 3,4 We present a case of coarctation of the aorta diagnosed in a teenage girl with the combination of an aortic arch coarctation, a "cauliflower-like" saccular aneurysm, and stenosis at the origin of the left subclavian artery, which was successfully treated with a hybrid approach.…”

Methods and clinical outcomes of in situ fenestration for aortic arch revascularization during thoracic endovascular aortic repair

“…Quick-Fenestrater (Luoyin Medical Apparatus Company, Suzhou, China) composed of a stabilizing stent and a needle had been used to preserve a left common carotid artery intentionally covered by an Ankura endograft (Lifetech Inc., Shenzhen, China). 36 The other novel needle puncture system developed by Wang et al 37 composed an adjustable puncture needle (Lifetech Inc., Shenzhen, China) in conjunction with a steerable Fustar sheath (Lifetech Inc., Shenzhen, China). 19 2009 Talent Laser 1/1 0 0 Sonesson et al 20 2009 Zenith Needle 2/2 0 0 Manning et al 21 2010 Zenith Needle 1/1 0 0 Hongo et al 22 2011 TAG Needle 1/1 0 0 Ahanchi et al 23 2012 Talent, Zenith Laser 5/6 0 0 Redlinger et al 24 2013 Talent The adjustable needle had three puncture depths and a compliant balloon at the tip for fixation and centralization.…”

“…Cutting balloon was used to tear the graft fabric in 12 patients (12/99, 12%). Low profile non-compliant balloon, especially high-pressure balloon (Mustang, Boston Scientific, USA) [35][36][37] was used in the remaining 87 patients (87/99, 88%).…”

<p>Coarctation of Aorta and Post-Stenotic Dissecting Aortic Aneurysm Successfully Treated with Endovascular Stent</p>

“…2 Endovascular procedures have opened a new dimension in treatment of thoracic aorta pathologies and are an excellent solution particularly in complex cases with high morbidity and mortality risk. 3 …”