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  • Title: Endovascular stent-graft repair of late pseudoaneurysms after surgery for aortic coarctation.
    Author: Zipfel B, Ewert P, Buz S, El Al AA, Hammerschmidt R, Hetzer R.
    Journal: Ann Thorac Surg; 2011 Jan; 91(1):85-91. PubMed ID: 21172491.
    Abstract:
    BACKGROUND: We analyzed the potential of endovascular stent grafts to treat late aortic pseudoaneurysms after coarctation repair. METHODS: Eight patients (7 male; age 28 to 58, mean 43 years) presented with aortic pseudoaneurysms after primary repair performed at the age of 5 to 27 (mean 12) years; 2 patients had rupture with hemorrhagic shock. The mean interval between the procedures was 31 (19 to 42) years; one patient had 3 previous operations. This subset represents 2.2% of our overall experience in thoracic endovascular repair (n=368). Thoracic endografts were implanted using the transfemoral technique. Custom-made reverse tapered stent grafts were used in 4 cases. The left subclavian artery (LSA) was covered in 5 patients. Protective transposition of the left subclavian artery was performed in 4 patients. RESULTS: Hospital mortality was 12.5%; 1 patient died from secondary rupture after emergency repair. Primary complete exclusion of the aneurysm was achieved in 6 patients. Secondary exclusion after implantation of a second stent graft was successful in the second rupture patient. No endoleak was present at discharge. All discharged patients are alive after 8 to 63 (mean 36) months. Follow-up computed tomography or transesophageal echocardiography revealed no secondary endoleaks or late expansion. The pseudoaneurysms had shrunk completely in 3 patients, were reduced in size in 2 patients, and remained unchanged in 2 patients. No late secondary interventions were noted. CONCLUSIONS: Single piece, reversed, tapered stent grafts adapt better to the special anatomy of the hypoplastic aortic arch. Midterm results are excellent; complete shrinkage in 50% is remarkable. However, the long-term behavior of these implants in young patients requires further evaluation and surveillance.
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