Hybrid Repair of Late-Onset Pseudoaneurysm After Previous Surgical Coarctation Repair

Abstract

Coarctation of the aorta is a congenital malformation that has long been considered completely correctable with appropriate surgery in childhood. Late thoracic pseudoaneurysms develop in 5–12% of patients undergoing repair for coarctation of the aorta, the incidence varying with the method of repair when the first time that coarctation has been diagnosed. Two cases have been reported in this article. The first patient who is a 35-year-old male had the saccular pseudoaneurysm which sized 6.5×7.5 cm placed in the aortic arch and included the left common carotid artery which occurred as a late-onset complication after open end-to-end repair of the coarctation. A hybrid repair such as left carotid-subclavian bypass in the operation room and after then thoracic endovascular aortic repair intervention in the angiography room was compromised by the surgical team. The second patient who is 30-year-old male had an aortic aneurysm which sized 6.2×7.2 cm placed in the descending aorta that was originated from next to the orifice of the left subclavian artery. He had a history of aortic coarctation and underwent open surgical repair 14 years prior. The surgical procedure initiated with an exploration of the right axillary artery then a median sternotomy was performed. Each of the supra-aortic branches is prepared. The aortic valve was bicuspid and normofunctional. The aneurysm was resected up to the aortic root, followed by a proximal anastomosis using a 28 mm Dacron graft. Subsequently, the cross clamp was placed on the brachiocephalic artery. Then, the frozen elephant trunk procedure was performed. The left subclavian artery anastomosed above the separated graft using 10 no dacron graft. The patient weaned from cardiopulmonary bypass without any problems, stayed in the ICU for 2 days, and discharged 2 weeks after the operation. Hybrid treatment combines endovascular intervention and extra-anatomic bypass as carotid-subclavian bypass performed in this case successfully. However, these procedures; both of them can be very challenging and they carry their own potential pitfalls; pre-operative planning with a whole surgical team makes this safer and easier.