Endovascular repair of pseudoaneurysm associated with coarctation of the aorta

Abstract

A 33-year-old man with a history of aortic coarctation presented to our group. His initial aortic repair as an infant involved a patch augmentation of his proximal descending thoracic aorta. After a 7-year interval, a planned repeat patch augmentation was abandoned due to scarring, and an ascending-to-descending 16-mm Dacron graft was placed. Subsequent aneurysmal dilation of the ascending aorta was repaired with a valvesparing root replacement using a 24-mm Dacron graft. Sequential computed tomography surveillance demonstrated progressive aneurysmal dilation of the distal anastomosis of the jump graft to the native aorta (Cover; A). The native segment of coarcted aorta remained patent. Of note, the patient was completely asymptomatic and remained in good health. The patient underwent an endovascular repair of the aneurysmal dilation. Aftera femoral cutdown,a14 10Amplatzer (AGAMedical,Plymouth,Minn) vascular plug was deployed in the distal native descending arch to prevent antegrade filling of the pseudoaneurysm but allow for flow in the great vessels. Subsequently, the pseudoaneurysm was excluded using a three-component Talent (Medtronic Corp, Santa Rosa, Calif) thoracic endograft (B). Postplacement images demonstrated exclusion of the pseudoaneurysm and preservation of the great vessels (C). The patient’s postoperative course was unremarkable, and he was discharged home on postoperative day 2.