Published online before print December 8, 2003, doi: 10.1161/01.CIR.0000106902.51626.AF
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(Circulation. 2003;108:2967.)
© 2003 American Heart Association, Inc.
Brief Rapid Communications |
Percutaneous Endovascular Repair of Aneurysm After Previous Coarctation Surgery
From the Division of Cardiology at the University Hospital Rostock, Rostock School of Medicine, Rostock, Germany.
Correspondence to Christoph A. Nienaber, MD, Division of Cardiology, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str 6, 18057 Rostock, Germany. E-mail christoph.nienaber{at}med.uni-rostock.de
Received May 13, 2003; de novo received July 18, 2003; revision received September 23, 2003; accepted October 21, 2003.
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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