Adult thoracic and abdominal aortic coarctation, combined value of MSCTA and conventional angiography in endovascular management

Abstract

ObjectiveTo detect the value of MSCTA in diagnosis and preplanning in endovascular management of adult thoracic and abdominal coarctation. The additional value of conventional angiography before or during the procedures is explained. The follow-up by either techniques is evaluated for early detection of re-coarctation and re-intervention. Patients and methodsThis retrospective study included 22 patients, 9 females and 13 males, age ranging from 17 to 49years. The main clinical presentation was hypertension (n=15). All patients were evaluated by MSCTA and conventional angiography with pressure gradient studies for preoperative evaluation and planning of treatment. Follow-up MSCTA was done at 6months interval for 3years. ResultsMSCTA detected suprarenal MAS (n=3), infrarenal and juxtarenal MAS (n=10), pre- and post-coarctation dilatation of the thoracic aorta and subclavian (n=4), thoracic collateral pathways (n=5). Mean narrowest diameter is 2.3mm (1.2–4.5mm). In conventional angiography peak systolic gradient decreased from 33 to 2mmHg. Successful endovascular repair was done in n=15, PTA was done alone in 6 and PTA and stenting were done in n=9. Endovascular re-intervention was done in n=3. ConclusionAortic COA could be found in any segment of the aorta. Proper identification of the anatomical details and pressure gradient studies are important factors affecting the plan of management.