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Role of endovascular repair in the management of late pseudo-aneurysms following open surgery for aortic coarctation

^a Adult Cardiac Surgery Unit, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
^b Cardiovascular Radiology Unit, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
^c Pediatric Cardiac Surgery Unit, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

Received 12 January 2009; received in revised form 21 April 2009; accepted 27 April 2009.

^_* Corresponding author. Address: Cardiothoracovascular Department (Pad 21), University Hospital S. Orsola, Via Massarenti 9, 40138 Bologna, Italy. Tel.: +39 051 6364747; fax: +39 051 345990. (Email: rossella.fattori{at}unibo.it).

Background: Coarctation of the aorta accounts for almost 5% of all congenital cardiac malformations, and it is usually treated by open surgical procedures. Despite the excellent primary results, many patients may develop anastomotic pseudo-aneurysms, associated with considerable morbidity and mortality rates. We investigated the role of endovascular repair as an alternative to open re-do surgery on the descending aorta. Methods: We retrospectively collected data of 11 consecutive patients who presented with pseudo-aneurysms of the descending aorta following previous surgical repair of congenital aortic coarctation. Nine patients developed a pseudo-aneurysm after patch aortoplasty, while an interposition graft repair was performed in two cases. Seven patients underwent an endovascular repair (26.9 years after the previous open surgery). Four patients with a pseudo-aneurysm after coarctation repair associated with arch hypoplasia underwent conventional open re-operation. Results: No complications or death were observed in the conventional surgical group. Technical success was obtained in all patients who received a stent-graft procedure. More than one stent graft was necessary only in one case. A left carotid–left subclavian artery bypass was performed in three patients. Type II endoleak was detected by angiography in one patient who had previously undergone subclavian re-vascularisation. The median follow-up (FU) was 44.5 months and was 100% complete. Neither re-operations nor complications or deaths occurred during FU. Conclusions: Endovascular repair of pseudo-aneurysms following open surgery for aortic coarctation is feasible and safe. However, more patients and longer follow-up are necessary to assess the efficacy of this promising less-invasive alternative to open re-do surgery.

Key Words: Aortic coarctation • Pseudo-aneurysm • Descending thoracic aorta • Endovascular stent-graft repair