Endovascular stent-graft repair of late pseudoaneurysms after surgery for aortic coarctation.

Abstract

We analyzed the potential of endovascular stent grafts to treat late aortic pseudoaneurysms after coarctation repair. Eight patients (7 male; age 28 to 58, mean 43 years) presented with aortic pseudoaneurysms after primary repair performed at the age of 5 to 27 (mean 12) years; 2 patients had rupture with hemorrhagic shock. The mean interval between the procedures was 31 (19 to 42) years; one patient had 3 previous operations. This subset represents 2.2% of our overall experience in thoracic endovascular repair (n=368). Thoracic endografts were implanted using the transfemoral technique. Custom-made reverse tapered stent grafts were used in 4 cases. The left subclavian artery (LSA) was covered in 5 patients. Protective transposition of the left subclavian artery was performed in 4 patients. Hospital mortality was 12.5%; 1 patient died from secondary rupture after emergency repair. Primary complete exclusion of the aneurysm was achieved in 6 patients. Secondary exclusion after implantation of a second stent graft was successful in the second rupture patient. No endoleak was present at discharge. All discharged patients are alive after 8 to 63 (mean 36) months. Follow-up computed tomography or transesophageal echocardiography revealed no secondary endoleaks or late expansion. The pseudoaneurysms had shrunk completely in 3 patients, were reduced in size in 2 patients, and remained unchanged in 2 patients. No late secondary interventions were noted. Single piece, reversed, tapered stent grafts adapt better to the special anatomy of the hypoplastic aortic arch. Midterm results are excellent; complete shrinkage in 50% is remarkable. However, the long-term behavior of these implants in young patients requires further evaluation and surveillance.