Suprarenal Aortic Occlusion Due to Coral Reef Calcification: Successful Endovascular Management Assisted by Intravascular Lithotripsy and Visceral Protection

Abstract

Purpose: Suprarenal aortic occlusion due to coral reef calcification has been considered not suitable for endovascular therapy because of visceral artery involvement. Unfortunately, open surgical treatment also carries high morbidity and mortality. We describe here successful endovascular management of a case of suprarenal aortic occlusion due to coral reef calcification with the use of intravascular lithotripsy (IVL) and visceral protection. Case Report: A 72-year-old women presented with uncontrolled hypertension, heart failure, and intermittent claudication. She was found to have occlusion of suprarenal aorta due to coral reef calcification at the level of the celiac artery. Celiac, superior mesenteric, and left renal arteries had stenosis. Right renal artery was normal. Intravascular lithotripsy–assisted balloon angioplasty and stenting of the aorta was done. Distal embolic protection of right renal artery and superior mesenteric artery was done during this procedure. Post procedure, there was no pressure gradient across the aortic stenosis, and all visceral arterial flow was maintained. Her cardiac function improved and hypertension could be managed with a single drug. Her pedal pulses became palpable Conclusion: Coral reef calcification of suprarenal aorta can be safely managed by endovascular therapy using IVL and distal embolic protection of the visceral arteries.

Surgical Strategies and Long-Term Outcomes for Complex Coral Reef Aorta with Multisegmental Involvement: A Case Report

“…While recent advances in endovascular techniques, including stent grafts and lithotripsy, have shown promise in managing aortic stenosis in CRA, their use is limited to specific cases because of potential occlusion of the vital aortic branches, particularly in cases with visceral involvement. Additionally, lithotripsy carries the risk of embolization and requires the use of protection devices [ 17 , 18 ]. The systematic review by Baldaia et al [ 2 ], which involved 124 CRA cases, revealed that 88.7% of patients underwent open surgery, 8.9% received endovascular treatment, and 2.4% had laparoscopic surgery.…”

Challenging Endovascular Treatment of Coral Reef Aorta and a Literature Review

“…7 In the last decade, the endovascular method seems to make its appearance and is the protagonist in the treatment of selected patients with CRA who cannot be treated with the open method. According to the current literature and platforms, the terms “endovascular stent-graft therapy” and “coral reef aorta” coexist and appear since 2008, and since then, only 13 articles ( Table 1 ) 3 4 5 8 10 11 12 13 14 15 16 17 18 have been published, most of them in the past 3 years. This is probably because vascular surgeons' familiarity with the endovascular technique and the appearance of newer and more advanced endovascular tools encourage vascular surgeons to dare to use the method.…”

“…Recorded cases of endovascular treatment with stent graft of coral reef aorta reported in bibliographic databases and platforms[3][4][5]8,[10][11][12][13][14][15][16][17][18] …”