Published Online
on December 8, 2003

A more recent version of this article appeared on December 16, 2003

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Submitted on May 13, 2003
Revised on September 23, 2003
Accepted on October 21, 2003

Percutaneous Endovascular Repair of Aneurysm After Previous Coarctation Surgery

Hüseyin Ince MD, Michael Petzsch MD, Tim Rehders MD, Stephan Kische , Thomas Körber MD, Frank Weber MD, and Christoph A. Nienaber MD^*

From the Division of Cardiology at the University Hospital Rostock, Rostock School of Medicine, Rostock, Germany.

^* To whom correspondence should be addressed. E-mail: christoph.nienaber{at}med.uni-rostock.de.

Background--Formation of aortic aneurysm late after surgical repair of coarctation carries a significant risk of rupture and lethal outcome, and repeat surgery is associated with a 14% in-hospital mortality rate and morbidity from paraplegia, injury to the central nervous system, or from bleeding. The potential of nonsurgical endovascular repair by the use of stent-grafts in lieu of repeat surgery for postcoarctation aneurysm is unknown.

Methods and Results--The concept of postsurgical endovascular stent-graft placement was evaluated with respect to feasibility and safety in 6 consecutive patients with late aneurysm formation after coarctation repair. All patients had aneurysm formation late after patch aortoplasty; placement of an elephant trunk during surgical repair of secondary type I dissection preceded formation of a local aneurysm in 2 cases. Patient age was 49±12 years, ranging from 31 to 68 years. Transluminal placement of customized stent-grafts was successful, with no 30-day or 1-year intervention-related mortality or morbidity. Follow-up survey of 11 to 47 months revealed optimal reconstruction of the thoracic aorta; 1 patient died 11 months after endovascular repair from cancer.

Conclusions--Nonsurgical aortic reconstruction of postsurgical thoracic aneurysms forming late after coarctation repair is safe and feasible; interventional stent-graft placement has the potential to avoid repeat surgery of postsurgical aortic aneurysm.

Key words: coarctation • aneurysm • grafting • stents • aorta

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