Hybrid Surgical Approach to a Giant Post-Coarctation Aortic Aneurysm

Purpose: To report a rare case of giant aortic coarctation (CoA)-related descending thoracic aneurysmal degeneration, complicated by an acute aortic dissection. Case Report: A 57-year-old man referred with acute chest pain to the emergency department. A computed tomography angiography (CTA) revealed...

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Bibliographic Details
Published in:Journal of endovascular therapy 2021-12, Vol.28 (6), p.961-964
Main Authors: Di Domenico, Rossella, Fargion, Aaron Thomas, Speziali, Sara, Petroni, Rachele, Villani, Flavio, Esposito, Davide, Pratesi, Carlo
Format: Article
Language:English
Subjects:
Aortic Aneurysm - surgery
Aortic Aneurysm, Thoracic - diagnostic imaging
Aortic Aneurysm, Thoracic - etiology
Aortic Aneurysm, Thoracic - surgery
Aortic Coarctation - complications
Aortic Coarctation - diagnostic imaging
Aortic Coarctation - surgery
Aortography
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation
Endovascular Procedures
Humans
Male
Middle Aged
Stents
Treatment Outcome
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Summary:Purpose: To report a rare case of giant aortic coarctation (CoA)-related descending thoracic aneurysmal degeneration, complicated by an acute aortic dissection. Case Report: A 57-year-old man referred with acute chest pain to the emergency department. A computed tomography angiography (CTA) revealed a CoA with a giant post-stenotic descending thoracic aneurysm (14 cm) and a concomitant left subclavian artery (LSA) aneurysm, complicated by an acute type B aortic dissection. A single-stage hybrid procedure was planned in an urgent setting. Initially, a left common carotid-to-left subclavian artery (LCCA-LSA) bypass was performed to gain a suitable proximal landing zone, the procedure was then completed with 3 thoracic endografts and 1 aortic dissection stent through a percutaneous femoral approach. The patient was discharged in postoperative day 8th without complications; the CTA performed at 1 month demonstrated patency of supra-aortic and visceral vessels, dilation of CoA site and exclusion of the false lumen. Conclusions: CoA is a congenital malformation rarely found in adults that may represent a challenge for the surgeon, especially when combined with a complication like an acute aortic dissection. This case shows that a hybrid approach is a safe and feasible treatment option even in such complex anatomies.
ISSN:1526-6028
1545-1550
DOI:10.1177/15266028211032954