Endovascular stent grafts for large thoracic aneurysms after coarctation repair

Background. Aneurysm formation is a complication not infrequently seen after repair of aortic coarctation and some may enlarge over time. Conventional management of large thoracic aneurysms after aortic coarctation repair has been akin to the surgical treatment of nonspecific aneurysms; however, hypothermic circulatory arrest has been more frequently required because of reoperations. We describe the treatment of a series of patients with large aneurysms using novel endovascular techniques. Methods. The database of patients undergoing thoracic endograft placement was reviewed to identify those with thoracic aneurysms after aortic coarctation repair. Clinical, operative, and radiographic data were assessed. Followup imaging included spiral computed tomography (CT) scans immediately after deployment, at 6 months, and yearly thereafter. Results. Of 9 patients that were identified, 7 presented for elective repair and 2 were emergencies. The aneurysms measured 4.7 to 7.3 cm in diameter on spiral CT scans. Seven patients underwent carotid to subclavian bypass and subclavian ligation. Endografts were placed abutting the origin of the left common carotid artery. Seven patients were treated with Zenith endografts (Cook, Inc, Bloomington, IN), and 2 with TAG devices (W. L. Gore & Associates, Flagstaff, AZ). Left common carotid angioplasty and stenting was performed in 4 patients. No major complications occurred. A mean follow-up of 24 months (range, 6.4 to 48 months) demonstrated no late endoleaks, ruptures, conversions, or migration. Conclusions. Placement of endovascular stent grafts is a less invasive approach for patients with thoracic aneurysm after aortic coarctation repair, provided there is no residual coarctation or arch hypoplasia. The potential to diminish the magnitude of the surgical procedure and consequences of aortic exposure in a reoperative field is promising and mandates further investigation.