Endovascular treatment for pseudoaneurysms after surgical correction of aortic coarctation

Pseudoaneurysm following a neonatal coarctation repair; a dreadful complication

Aneurysms of descending thoracic aorta following surgical repair of coarctation have been reported in literature. Almost always, they are seen in repairs involving prosthetic patch aortoplasty. We report a neonate who underwent resection and an extended end to end anastomosis repair of coarctation and subsequently developed a huge pseudoaneurysm at a 3-month follow-up. He underwent a repair of the same through a sternotomy approach under hypothermic low flow cardiopulmonary bypass. An autologous pericardial patch aortoplasty was done successfully.

Aortic Endoprosthesis for the Treatment of Native Aortic Coarctation and Concomitant Aneurysm in an Octogenarian Patient

We report a case of an 82-year-old female patient with native coarctation of the aorta and poststenotic aneurysm of the descending thoracic aorta. On consultation, she was receiving 4 antihypertensive drugs, and physical examination revealed nonpalpable lower-limb pulses with intermittent claudication at 50 min. Because of her age, high surgical risk and combination of lesions, endovascular treatment was suggested. Placement of a Valiant thoracic aorta endoprosthesis followed by coarctation angioplasty was performed. At 48 hr, the patient was discharged on 1 antihypertensive drug, palpable pulses on both limbs and a normal ankle-brachial index. At 1 month follow-up, the patient remained as discharged and multislice computed tomography angiography depicted complete coarctation expansion without residual stenosis, exclusion of the aortic aneurysm, and no signs of endoleaks.

Reverse elephant trunk technique: a novel approach to pseudoaneurysm repair

Traditional surgical access to the upper descending aorta is via a left thoracotomy. For postcoarctation pseudoaneurysm repair, this approach is difficult because of the risk of rupture while dissecting the aorta for proximal and distal control. Access from a median sternotomy may be safer, but is difficult because of the depth of the wound and because of the angle of approach to the distal aspect of the repair site. We describe a novel approach via a median sternotomy incision, using circulatory arrest and "elephant trunk" principles to achieve tube graft replacement of the aneurysmal section of aorta.