Transcatheter and endovascular stent graft management of coarctation-related pseudoaneurysms

The Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, , Bristol, UK.
Heart (British Cardiac Society) (Impact Factor: 5.6). 07/2013; 99(17). DOI: 10.1136/heartjnl-2012-303488
Source: PubMed


Surgical correction of congenital aortic coarctation can lead to a number of important problems including late pseudoaneurysm formation. Redo surgery has a significant risk. Endovascular stent graft repair is increasingly used but there are limited data regarding this indication. We describe the experience of two UK congenital referral centres.
Retrospective analysis of patients treated with endovascular aortic stent grafting for late pseudoaneurysms.
Two UK congenital heart centres, Bristol Heart Institute and Leeds General Infirmary.
17 patients were treated 2006-2012. This represents all patients treated with this technique.
Procedural and postprocedure success and complications.
The average time from index repair to endovascular repair of pseudoaneurysm was 24.6 years. The majority (70.6%) had patch aortoplasty as the original surgical procedure and 41.2% were not under follow-up or discharged. Stent grafting procedural success rate was 100%. Median hospital stay postprocedure was 3 days. There was no procedural mortality or immediate complication. There were four minor early and three minor late complications. Imaging follow-up was available for an average of 31.6 months (range 6-65 months). All patients have demonstrated positive remodelling of the pseudoaneurysm with no incidence of continued expansion or stent graft failure up to 5 years following implant.
Endovascular stent graft treatment of pseudoaneurysms show promising results in a population who have a high risk of surgical re-intervention. Complication rates appear to be low and recovery is quick. Longer-term data remain essential to scrutinise stent graft performance in this situation.

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    ABSTRACT: Introduction: The prevalence of congenital aortic coarctation is 4 in 10 000 live birth. Aortic coarctation is typically located in the aortic isthmus, but it may occur at atypical sites. Treatment options include both surgical and endovascular interventions. In patients undergoing surgical or endovascular intervention late complications such as recoarctation or aortic aneurysm may develop. Aim: The aim of the authors was to analyse their own experience in late complication and treatment options of aortic coarctation operated in childhood. Method: Retrospective analysis of data of 32 patients treated between 1980 and 2014 for late complications 8-42 years after surgical treatment of aortic coarctation. Results: In 28 patients aneurysm formation after isthmic patch plasty was found. Two patients had aortobronchial fistula, 2 patients showed anastomosis disruption and 2 patients had graft stenosis. During operation hybrid solution was performed in 23 patients, isthmic aorto-aortic inlay graft interposition in 5 patients, aorto-aortic bypass in 2 patients, subclavio-aortic bypass in 2 patients, graft patch plasty in one patient and ilio-renal bypass in one patient. Complications included severe intraoperative bleeding in one patient and pneumothorax in one patient. No early or late mortality occurred. Conclusions: The authors conclude that life long control is mandatory in order to detect late complications in patients who underwent operation of aortic coarctation in childhood. Orv. Hetil., 2014, 155(30), 1189-1195.
    Orvosi Hetilap 07/2014; 155(30):1189-1195. DOI:10.1556/OH.2014.29915