Endovascular management of adult coarctation and its complications: intermediate results in a cohort of 22 patients

Shennib, Hani; Rodriguez-Lopez, Julio; Ramaiah, Venkatesh; Wheatley, Grayson; Kpodonu, Jacques; Williams, James; Olson, Dawn; Diethrich, Edward B.
February 2010
European Journal of Cardio-Thoracic Surgery;Feb2010, Vol. 37 Issue 2, p322
Academic Journal
Abstract: Objective: To determine the safety and effectiveness of current endovascular treatment in adult patients with thoracic aortic coarctation and its complications. Methods: A cohort of 22 patients was treated for late presenting primary or recurrent coarctation or aneurysmal formation at varying intervals following childhood intervention. Results: Ten patients with recently discovered de novo coarctations were treated with balloon-expandable stents, and an endoluminal graft (ELG) was used in one additional patient. In the other 11 patients with recurrent lesions, three underwent repeat balloon dilation and stenting; eight patients with recurrence with aneurysms received ELGs. The gradients across the coarctation decreased from 49+16 to 4+7mmHg (p =0.001), and the diameters increased from 10+4 to 19+4mm (p =0.001). In five of the eight patients (63%) with aneurysms, the ELG covered the subclavian artery, and a carotid subclavian bypass was necessary. Two patients required iliac artery access. No early major complications occurred. At mean follow-up of 31+15.6 months, one patient with type II leak resolved spontaneously and another developed neck dilation and type I leak, requiring a second ELG placement. All patients except one had improvements in symptoms and better hypertension control. Conclusions: We conclude that primary or secondary endovascular intervention in adults with de novo or recurrent coarctation and aneurysms is feasible with good intermediate results.


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