Percutaneous recanalization and balloon angioplasty of congenital isolated local atresia of the aortic isthmus in adults

Long-term follow-up after recanalisation of aortic arch atresia

AIMS

Aortic arch atresia (AAA) is one of the rarest obstructive defects. The presence of this anomaly in adult age is uncommon. The typical anatomic feature consists of a complete occlusion of the membranous obstruction resulting in an acquired atresia without flow continuity between the proximal and distal segments. This feature is important in determining the feasibility of percutaneous intervention. The aim of the present study was to share long-term follow-up data of adult patients with AAA requiring percutaneous interventions for the management of this rare anomaly involving five different centres.

METHODS AND RESULTS

Retrospective data of 19 patients (12 males, 63.2%, mean age 32.2±18.9 years) diagnosed with AAA treated in five different centres between 1999 and 2017 were collected. All patients underwent percutaneous recanalisation by (1) radiofrequency (RF) system (five patients, 26.3%), (2) extra-stiff guidewire (12 patients, 63.2%), and (3) transseptal needle (two patients, 10.5%). All procedures were subsequently followed by covered stent implantation. Two patients developed complications during the procedure and one of them died. Over a median follow-up of 4.94 years, four (21%) patients were able to be weaned from medications for hypertension. All the patients underwent reassessment for recurrence or restenosis during the follow-up. Seven (36.8%) patients underwent successful stent dilatation with a balloon. After the intervention, one patient experienced a late complication; however, one patient died due to an unknown cause believed to be unrelated to the previous recanalisation procedure.

CONCLUSIONS

Percutaneous treatment of AAA is feasible with good long-term survival. This study reports the largest case series so far available in the literature.

Percutaneous recanalization of totally occluded coarctation of the aorta in children using Brockenbrough needle and covered stents

Percutaneous treatment of totally occluded coarctation of the aorta has been reported predominantly in adults. The success and challenges of this procedure in children is reported in few patients. We report an outcome of percutaneous treatment of three children with completely occluded coarctation of the aorta. The age range was 9-14 years. All the patients had upper limb hypertension. One case had severe left ventricular dysfunction. In all cases, a pediatric Brockenbrough needle and a covered stent were implanted. Recanalization and implantation of a covered stent was successful in all patients. One of these patients developed transient postcoarctectomy syndrome. Percutaneous recanalization of totally occluded coarctation of the aorta using Brockenbrough needle and a covered stent in children is feasible and effective.

Interrupted aortic arch with post-interruption aneurysm and bicuspid aortic valve in an adult: a case report and literature review

Interrupted aortic arch in adults is rare with a limited number of reported cases. We describe a case of a 53-year-old woman with interrupted aortic arch, bicuspid aortic valve, and post-interruption saccular aneurysm of the aorta. To our knowledge, this is only the second report of an adult patient with all 3 abnormalities. We also review the literature on this unusual condition and discuss its relationship with coarctation of the aorta.

Percutaneous reconstruction of aortic isthmus atresia using coronary total occlusion technique

Aortic isthmus atresia is an extreme form of coarctation presenting in adults and usually calls for surgical correction. In this report, we present our initial experience with the first four cases successfully treated percutaneously using dedicated coronary total occlusion wires and techniques. <Learning objective: This case series shows a technique to cross totally occluded coarctation using the coronary chronic total occlusion technique which has not been described in the literature till date. Further, these cases although not common are not as rare either as is evident by our experience of four consecutive cases observed over a period of 6 years in a large tertiary care centre. The readers could benefit from applying the same principles for similar cases that they would see in their clinical practice.>.

Operative challenges in management of concurrent interrupted aortic arch and descending thoracic aortic aneurysm

Interrupted aortic arch is a rare finding in the adult patient. This condition in combination with a descending thoracic aortic aneurysm is an even more exceptional occurrence. Surgical management includes open, endovascular, and hybrid options. We present the case of a 57-year-old man with interrupted aortic arch and concomitant descending thoracic aortic aneurysm, review characterization of this entity, and discuss management options with consideration to associated risks.

Techniques for transcatheter recanalization of completely occluded vessels and pathways in patients with congenital heart disease

Occlusions of major vessels in patients with congenital heart disease may occur due to a variety of factors. These occlusions are often felt to be best addressed surgically; however, we and others have been successful in recanalizing most of these vessels in the catheterization laboratory. Most of these patients will require multiple procedures in the catheterization laboratory to ensure vessel patency and to facilitate vessel growth. Physicians performing the procedure should have a thorough understanding of the anatomic considerations for the intended procedure and have access to a variety of devices and equipment to optimize the result of the procedure. In this article, we review some of the technical aspects that are vital for the success of the procedure.

Use of radiofrequency then stent implantation for recanalization of complete aorta coarctation

Recanalization of a complete coarctation with isthmus occlusion was successfully accomplished in a 16-year-old patient using radiofrequency. This allowed the insertion and deployment of a covered stent to reestablish flow continuity across the isthmus. No complications were encountered. To the authors' knowledge this is the first case of radiofrequency use for complete coarctation, and among the rare cases of complete coarctation addressed primarily percutaneously to be reported.

Transcatheter therapy of long extreme subatretic aortic coarctations with covered stents

We report our experience with the transcatheter treatment of long extreme subatretic coarctations in four adult patients by the implantation of covered stents. The minimal narrowing of the stenosis was 0.014'' to 2 mm; the hypoplastic distance measured between 21 and 42 mm. Polytetrafluoroethylene-covered stents 39-50 mm long were implanted and 6 months later redilated. Residual pressure gradients ranged from 0 to 10 mm Hg. One stent fracture required the implantation of a second stent after 6 months. The follow-up period ranges from 18 to 4 months and has been uneventful so far. Covered stents seem to have the potential to extend the limits of interventional therapy to extreme forms of aortic coarctations.

Recanalization of a discrete atretic right pulmonary artery segment with a new radiofrequency system

We describe a case in which a discrete atretic segment of the right pulmonary artery (due to a Blalock-Taussig shunt) was reconstructed using a new radiofrequency system, balloon dilation, and stent implantation in an 18-month-old patient. The shunt was coil-occluded. The technique and applications of this novel approach are discussed.