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Case Reports
. 2020 Mar 17:47:22-25.
doi: 10.1016/j.ejvsvf.2020.02.010. eCollection 2020.

Successful Ascending to Descending Aortic Bypass and Endovascular Embolisation of a Late Pseudoaneurysm Following Patch Aortoplasty for Coarctation of the Aorta

Takeshi Kamada  1 , Ryoichi Tanaka  2 , Tomoyuki Iwase  1 , Kotaro Oyama  3 , Hajime Kin  1
Affiliations
Case Reports

Successful Ascending to Descending Aortic Bypass and Endovascular Embolisation of a Late Pseudoaneurysm Following Patch Aortoplasty for Coarctation of the Aorta

Takeshi Kamada et al. EJVES Vasc Forum. .

Abstract

Introduction: A late aortic aneurysm at the site of previous open surgery for coarctation of the aorta (CoA) is a life threatening complication. Several strategies have been reported, however, these strategies have issues. This is the report of a case involving successful ascending to descending aortic bypass concomitant with endovascular embolisation for a pseudoaneurysm.

Report: The patient was a 23 year old man with a history of patch aortoplasty for coarctation of the aorta (CoA) via a left thoracotomy and patch closure of a ventricular septal defect. Enhanced computed tomography (CT) angiography performed in 2014 revealed a pseudoaneurysm at the site of the previous patch aortoplasty. CT also revealed a hypoplastic and severely kinked aortic arch that made it difficult to perform conventional thoracic endovascular aortic repair for this aneurysm. Therefore in order to prevent rupture, a combination of ascending to descending aortic bypass and endovascular embolisation using Amplatzer vascular plugs and coils was employed. Transection of the aortic arch and transposition of the left subclavian artery were performed to prevent antegrade flow into the aneurysm.

Discussion: The aneurysm was successfully excluded without complications. CT performed three years after the operation showed that the pseudoaneurysm had shrunk completely. Extra-anatomic bypass concomitant with endovascular embolisation for a late coarctation patched site aneurysm might be an alternative strategy that should be carefully considered in specific cases.

Keywords: Ascending to descending aortic bypass; Coarctation of the aorta; Endovascular embolisation; Open surgery; Pseudoaneurysm.

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Figures

Figure 1
Figure 1
Pre-operative three dimensional computed tomography shows a pseudoaneurysm of the proximal descending thoracic aorta and shows that the aortic arch is hypoplastic and severely kinked.
Figure 2
Figure 2
Intra-operative angiography shows that Amplatzer vascular plugs (AVPs) have been deployed between the left subclavian artery and the proximal descending thoracic aorta. Coils are also deployed to fill the gap between the AVPs. There is no evidence of anastomotic stenosis of the ascending to descending aortic bypass or the graft to left axillary artery bypass.
Figure 3
Figure 3
(A) Post-operative three dimensional computed tomography (CT) shows that the sac of the pseudoaneurysm has thrombosed. The two bypasses are patent without evidence of anastomotic stenosis. (B) CT performed three years after the operation shows that the aneurysm sac had shrunk completely.
See this image and copyright information in PMC

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