Suprarenal Aortic Occlusion Due to Coral Reef Calcification: Successful Endovascular Management Assisted by Intravascular Lithotripsy and Visceral Protection

Abstract

Purpose: Suprarenal aortic occlusion due to coral reef calcification has been considered not suitable for endovascular therapy because of visceral artery involvement. Unfortunately, open surgical treatment also carries high morbidity and mortality. We describe here successful endovascular management of a case of suprarenal aortic occlusion due to coral reef calcification with the use of intravascular lithotripsy (IVL) and visceral protection.

Case report: A 72-year-old women presented with uncontrolled hypertension, heart failure, and intermittent claudication. She was found to have occlusion of suprarenal aorta due to coral reef calcification at the level of the celiac artery. Celiac, superior mesenteric, and left renal arteries had stenosis. Right renal artery was normal. Intravascular lithotripsy-assisted balloon angioplasty and stenting of the aorta was done. Distal embolic protection of right renal artery and superior mesenteric artery was done during this procedure. Post procedure, there was no pressure gradient across the aortic stenosis, and all visceral arterial flow was maintained. Her cardiac function improved and hypertension could be managed with a single drug. Her pedal pulses became palpable.

Conclusion: Coral reef calcification of suprarenal aorta can be safely managed by endovascular therapy using IVL and distal embolic protection of the visceral arteries.

Keywords: aortic calcification; aortic stenting; coral reef aorta; intravascular lithotripsy; visceral protection.