Transcatheter and endovascular stent graft management of coarctation-related pseudoaneurysms

Objective 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. Design Retrospective analysis of patients treated with endovascular aortic stent grafting for late pseudoaneurysms. Setting Two UK congenital heart centres, Bristol Heart Institute and Leeds General Infirmary. Patients 17 patients were treated 2006-2012. This represents all patients treated with this technique. Main outcome measures Procedural and postprocedure success and complications. Results The average time from index repair to endovascular repair of pseudoaneurysm was 24.6years. 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 3days. 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 31.6months (range 6-65months). All patients have demonstrated positive remodelling of the pseudoaneurysm with no incidence of continued expansion or stent graft failure up to 5years following implant. Conclusions 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.