Patch Aortoplasty Research Articles

Surgical management of traumatic rupture of aortic isthmus: a 25-year experience

Traumatic rupture of the thoracic aorta is a surgical emergency with a high mortality rate. This condition requires prompt diagnosis and expeditious evaluation to improve patient survival. The aim of this study is to evaluate the outcomes of early and late management of traumatic rupture of aortic isthmus in patients with blunt thoracic trauma. Between February 1980 and June 2005, 64 patients sustained blunt thoracic trauma underwent open surgical repair for traumatic rupture of the aortic isthmus (7 women, 57 men, and mean age 38 ± 14.3 years). Clinical signs of diagnostic principles in our series of patients were: chest pain and dyspnea (48.5 %), hemoptysis (23.5 %), and hypotension (15.5 %). All patients underwent a left posterolateral thoracotomy through the fourth or fifth intercostal space or median sternotomy. Extracorporeal circulation for spinal cord protection was installed in all patients. Of the 64 patients identified over the 25-year study period, 15 (23.5 %) underwent direct suture, 48 (75 %) underwent interposition graft repair, and 1 (1.5 %) experienced patch aortoplasty repair. The overall hospital mortality rate for the entire patient was 3 % due to multiple organ failure and myocardial infarction. No paraplegia occurred postoperatively. Three patients died during the follow-up period, two from myocardial infarction, and one from acquired immunodeficiency syndrome. Traumatic aortic rupture remains a potentially lethal injury and an ongoing therapeutic challenge. Open surgical technique to repair the traumatic rupture of aorta is a safe procedure: postoperative outcome was excellent and the complications observed that were with aortic endoprosthetic stent-grafts were avoided.

EComment. Antimicrobial vascular grafts in cardiac surgery

We read with great interest the paper by Yano et al. regarding the successful surgical management of an 81-year old female patient with a septic aortic pseudoaneurysm secondary to Escherichia coli, which presented as cardiac tamponade [1]. In our opinion, a few remarks with respect to the surgical strategy and types of vascular graft ought to be addressed. The term “mycotic aneurysm” was first used in 1885 by Sir William Osler because of the beaded and multilobulated appearance of the aneurysm formation occurring in malignant endocarditis [2]. However, the use of septic aortic pseudoaneurysm (SAP) in this case report is more accurate. Septic aortic pseudoaneurysm is used to describe aortic pseudoaneurysm caused by bacterial invasion of the vessel wall, with or without bacteremia. SAP is a potentially life-threatening aortic lesion. It is uncommon, but not rare, and an increasing incidence has been reported in recent years [2]. Treatment is usually bimodal with intensive antibiotic therapy as well as surgical repair; furthermore, surgical treatment of SAP remains challenging. A literature review of surgical treatment of SAP in the abdominal or thoracic portion of the aorta can be confusing [2]. Whether a patient should undergo extra-anatomic bypass grafting or in situ reconstruction with prosthetic graft or allograft is not well-established and remains a matter of ongoing debate. However, the most performed strategy in this setting is the in situ reconstruction with prosthetic graft. It consists of an aggressive and extensive debridement of infected tissue (aortic wall and surrounding tissue) and irrigation of the operative field with antiseptic agent. Aortic continuity is then reconstructed with an in situ graft and the prosthetic graft is protected with a great omentum pedicle. An extra-anatomic reconstruction is technically challenging but is not impossible, as stated by the authors. A review by Oz et al. [3] showed that the aforementioned technique applied in 24 patients with thoracic SAP is feasible; however it is more challenging because it requires multiple operations. Luo et al. [3] described a different technique to repair small SAP located on the distal aortic arch. Under cardiopulmonary bypass with deep hypothermia and circulatory arrest, they excise the SAP and repair the defect with patch aortoplasty. In the setting of small SAP, patch aortoplasty can be an alternative method; this was the case in the patient presented by Yano et al. [1] Antibiotic-bonded grafts (e.g., rifampicin-bonded Dacron grafts) and silver-coated Dacron grafts are increasingly been used in vascular surgery to prevent graft infection or to treat abdominal aortic infection with encouraging outcomes [4-5]. The availability of the silver-coated Dacron grafts in different types and sizes, its ease of use and its durability remain important advantages. To the best of our knowledge, these grafts have never been used to replace the thoracic aorta. We think that antimicrobial grafts can represent an alternative to aortic allografts and to standard Dacron grafts with omental wrapping and should be considered in the armamentarium of every cardiac surgeon. Conflict of interest: none declared

Successful Surgical Outcome of Coarctation of Aorta in an adult male

Coarctation of the aorta is a relatively common defect that accounts for 5-8% of all congenital heart defects. Coarctation of the aorta may occur as an isolated defect or in association with various other lesions, most commonly patent ductus arteriosus, bicuspid aortic valve and ventricular septal defect. The diagnosis of coarctation of the aorta may be missed or delayed unless there is a high index of suspicion and the presentation may be congestive heart failure in infant or hypertension in older children and adult. A case of coarctation of the aorta associated with patent ductus arteriosus having features of headache, exertional dyspnea and uncontrolled hypertension is being presented here. PTFE patch aortoplasty and ligation with transfixation of PDA was done. Post-operative period was uneventful and patient was discharged on 7th post-operative day. DOI: http://dx.doi.org/10.3329/uhj.v8i1.11671 University Heart Journal Vol. 8, No. 1, January 2012

Repair of a Penetrating Ascending Aortic Ulcer With Localized Resection and Extracellular Matrix Patch Aortoplasty

Penetrating ascending aortic ulcers are rarely encountered, yet they present significant risk of hemorrhage and aortic dissection. Expedient recognition and repair is of vital importance. The current management of penetrating ulcer of the ascending aorta includes replacement of the ascending aorta with a prosthetic graft. We describe our technique of repairing a penetrating ulcer of the ascending aorta with localized ulcer resection and extracellular matrix patch aortoplasty.

Aortic Aneurysms Remain a Significant Source of Morbidity and Mortality After Use of Dacron® Patch Aortoplasty to Repair Coarctation of the Aorta: Results from a Single Center

Aortic aneurysm formation after coarctation repair is a serious and life-threatening complication. Repairs using synthetic materials such as Dacron(®) may carry the highest risk of aneurysm formation and rupture. The authors sought to determine the prevalence of aneurysm formation in patients who previously underwent coarctation repair using Dacron(®) patch aortoplasty at their institution. Between 1977 and 1994, 63 patients underwent isolated coarctation repair using Dacron(®) patch aortoplasty. Aneurysms were defined as an aortic dimension 1.5 times that of the aorta at the level of the diaphragm as shown by angiography, computed tomography (CT) scan, or magnetic resonance imaging (MRI). Of 61 early survivors, 29 (47 %) experienced an aneurysm in the area of previous repair. Nine patients (31 %) had spontaneous rupture of the aneurysm, which caused death in seven cases. Elective or emergent aneurysm repair was performed for 20 patients without complication, and 2 patients are being monitored at this writing. The mean interval from patch placement to aneurysm repair was 15 years (range, 4-27 years). Overall freedom from the development of an aortic aneurysm was 97 % at 5 years, 90 % at 10 years, 69 % at 20 years, and 42 % at 25 years. After repair of coarctation using Dacron(®) patch aortoplasty, the risk for aneurysm formation in the area of repair and death from rupture is extremely high. Therefore, in accordance with the 2008 American Heart Association/American College of Cardiology (AHA/ACC) guidelines, all patients with repaired aortic coarctation should undergo either CT or MRI imaging at least every 5 years to assess for aortic aneurysm formation. More frequent imaging should be obtained for patients previously repaired with Dacron(®) patch aortoplasty.

Long-segment thoracoabdominal aortic occlusions in childhood

Developmental coarctation, hypoplasia, and occlusion of the abdominal aorta is a rare disease encompassing many differing etiologies and diverse methods of treatment. Long-segment thoracoabdominal aortic occlusion, an extreme manifestation of this disorder, has not previously been reported in children. Two pediatric patients with this entity, a 5- and 13-year-old with uncontrolled hypertension, underwent extensive arterial reconstructions for this entity and provided the impetus for this report. An ascending thoracic aorta to infrarenal aortic expanded polytetrafluoroethylene bypass was undertaken in the younger child. A distal thoracic aorto-bi-iliac artery expanded polytetrafluoroethylene bypass, with implantation of the left renal artery to one graft limb and a right renal artery bypass originating from the other limb, was performed in the older child. There were no major perioperative complications. Both patients were discharged with easily controlled blood pressures. They have remained normotensive at 13 and 14 months follow-up.

044 Endovascular and transcatheter management of coarctation-related aneurysms in adults

IntroductionAortic coarctation surgery is associated with a late risk of aneurysm formation. This is particularly seen with patch aortoplasty repair. These aneurysms have a high risk of rupture in the...

Combined aortic valve replacement and coronary artery bypass grafting for a calcified ascending aorta

Although a severely calcified ascending aorta is encountered infrequently, it presents formidable problems during cardiac surgery. We describe a case of severe aortic valve stenosis and coronary artery disease combined with a severely calcified ascending aorta. The patient was an 80-year-old man with a calcified ascending aorta. He successfully underwent an aortic valve replacement and a single coronary artery bypass graft (CABG) using a saphenous vein graft with the proximal end connected on a Dacron patch, which was used for aortoplasty of the calcified plate along the aortotomy. These procedures were performed under moderate hypothermia with aortic clamping. This patch aortoplasty can be a useful alternative in cases that require aortotomy and proximal anastomoses of a CABG on a calcified ascending aorta.

Letters to Editor Hypertension without renovascular stenosis: a rare case of abdominal aorta coarctation treated with percutaneous transluminal angioplasty

Letters to Editor Hypertension without renovascular stenosis: a rare case of abdominal aorta coarctation treated with percutaneous transluminal angioplasty

The Mid-term Result of Patch Aortoplasty for Adult Coarctation of the Aorta: The Report of Three Cases

要 旨：近年，成人大動脈縮窄症の治療に対しステントを用いたカテーテル治療が行われるようになり，手術との優劣が論じられるようになってきている。手術方法には以前より種々の方法が採用されており，いまだに議論のあるところである。今回，われわれは再手術の2症例を含む3症例に対して，血管アクセスの観点などからステントなどカテーテル治療は適当でないと判断し，手術侵襲，血管の性状からパッチ拡大術を施行した。術後遠隔期において重篤な合併症もなく良好な結果が得られたので，文献的考察を交えて報告する。

Multiple Time Aortic Valve Replacement

A 32-year-old female who had undergone aortic valve replacement (AVR) 10 years previously as a result of an episode of infective endocarditis with the pathogen Staphylococcus epidermidis, was admitted to the hospital with a history of appetite loss, chilling, relapsing fever up to 39℃, and left leg pain. Her medical history included Williams syndrome along with patch aortoplasty and aortic valve commissuroplasty 22 years earlier when she was 10 years old. The patient was lost to follow-up until age 16, when she was readmitted with native valve endocarditis. She was treated with AVR with a 21-mm CarboMedics mechanical valve (CarboMedics, Inc., Sorin Group, Burnaby, British Columbia, Canada) and graft interposition of the ascending aorta with a 20-mm Hemashield artificial graft (Maquet Cardiovascular, Wayne, NJ). She was again lost to follow-up until age 22, when she stayed the hospital again for a week with a fever. She underwent redo AVR again with a 21 mm Edwards MIRA mechanical valve (Edwards Lifesciences, Irvine, CA, USA). She was discharged December 15, 2000, and was prescribed a regimen of an anticoagulant, but the patient has not taken any warfarin since. However, she became pregnant twice and had an abortion and a birth without anticoagulation during this period. The blood culture yielded growth of Staphylococcus sanguis, which was sensitive to the initial treatment regimen. Immediate transthoracic echocardiography and transesophageal echocardiography demonstrated vegetations (0.75×0.2 and 0.8×0.3 cm linear oscillating masses), which were observed on the left ventricular side of the prosthetic aortic valve (Fig. 1). The increased infection parameters, including fever, leukocytosis, and ESR, and the blood culture again showed the presence of Staphylococcus sanguis and a sensitivity to ceftriaxone, so the treatment was continued. However, a linear oscillating mass at the prosthetic aortic valve was observed despite the clinical control of the infection. Consequently, re-redo AVR was performed with a 25-mm St. Jude mechanical valve on the 25th day after the initiation of antibiotic treatment. Following successful surgery, the patient recovered well and was discharged after six weeks of postoperative antibiotic treatment without any signs of infective endocarditis. Fig. 1 Vegetations (arrow) were observed at the left ventricular side of the prosthetic aortic valve and aortic regurgitation was seen by TEE. LV=left ventricle; LA=Left atrium; AV=Aortic valve (arrow head); Ao=Aorta. In spite of advances in medical and surgical treatment, infective endocarditis is still regarded as a serious disease [1]. Patients with previous infective endocarditis are considered at high risk of recurrent endocarditis, so significant attention should be paid to prevent any recurrences [2-5]. A large number of female patients with valvular heart disease will be of childbearing age at some point. This case shows a serious complication concerning a pregnant patient with prosthetic heart valves. Also, this patient was uncooperative with our treatment, and had low social standingswithout the benefit of formal education. In this case, prosthetic aortic valve replacement was performed during the second episode of infective endocarditis, and the patient was three months pregnant when she was admitted to the hospital with a history of fever for a week. She should have taken warfarin diligently and gone for regular check-ups to prevent a third infection. However, she discontinued anticoagulant medication and follow-up examination as an outpatient. As a result, she needed an abortion in order to undergo re-redo aortic valve replacement due to the second episode of endocarditis. Consequently, patients with prosthetic valves should be sufficiently educated about infective endocarditis before discharge, and preventive measures, such as effective personal hygiene, should be prescribed.

Ascending Sliding Arch Aortoplasty: A Novel Technique for Repair of Arch Hypoplasia

Coarctation of the aorta (CoA) is often associated with clinically significant hypoplasia of the aortic arch. Historically, patch aortoplasty or bypass procedures have been the preferred techniques when arch augmentation is required in children beyond infancy. While safe and effective, these approaches require prosthetic or biologic material without the potential for growth, or normal endothelial and physiologic elastic function. This retrospective study reviews the use of a novel technique, ascending sliding arch aortoplasty, that utilizes viable autologous tissue for repair of arch obstruction in children beyond infancy. Between April 2002 and January 2007, 8 patients ranging in age from 18 months to 15 years underwent repair of CoA with arch hypoplasia using ascending sliding arch aortoplasty. All patients were approached through median sternotomy, utilizing cardiopulmonary bypass and selective antegrade cerebral perfusion. There was no mortality or major morbidity. One toddler had pneumonia, resulting in an increased length of stay. Median duration of hospitalization was 5.8 days, ranging from 3 to 10 days. No patient had evidence of residual obstruction or recurrent CoA at a mean follow-up interval of 36 months. Ascending sliding arch aortoplasty for CoA with arch obstruction in children beyond infancy is a safe technique that can be accomplished without deep hypothermic circulatory arrest. There is no evidence of recurrence at midterm follow-up. Because the augmentation is accomplished with viable autologous aortic tissue, the potential for growth, preserved elasticity and endothelial function, and resistance to infection make this method attractive for use in the young.

Late Tamponade Secondary to Aortic Root Perforation by BioSTAR Septal Closure Device

We report a patient who presented with pericardial tamponade 9 months after percutaneous closure of a patent foramen ovale using a BioSTAR septal closure device (NMT Medical, Boston, MA). During the operation, bleeding was observed on the posterior aortic root caused by a nonendothelialized strut. The device was explanted, followed by pericardial patch aortoplasty and patch closure of the patent foramen ovale. This report presents a case of late tamponade related to the new-generation bioabsorbable BioSTAR device. Although late complications related with BioSTAR are rare, the presentation may be dramatic. A high index of suspicion and quick intervention is often lifesaving.

Huge Aortic Aneurysm After Balloon Angioplasty for Coarctation of the Aorta in an Infant

A 11-month-old boy was referred to our unit for operation. When he was 20 days old, he had balloon dilatation of the aortic coarctation at another institution. He also had a small ventricular septal defect. During the follow-up, asymptomatic aneurysm formation at the previous coarctation site was determined. On physical examination, there was a systolic mummur at the 4th intercostal space. The echocardiographic examination revealed a small perimembraneous-outlet ventricular septal defect and the aneurysm at the coartation site. Cardiac angiography revealed the giant aneurysm of the descending aorta that was 4.4 cm in diameter (Fig. 1; Clip 1). The surgical approach was made though a left posterolateral thoracotomy. At surgery, the aneurysm (Fig. 2) was incised longitudinally (Fig. 3) and both lateral walls and the anterior wall of the aorta that was involved in the aneurysm were resected. The remainder posterior wall was intact and was not integrated in the aneurysm tissue. Patch aortoplasty was performed with a Hemashield patch (Boston Scientific, Natick, MA). The patch was sutured to the aorta in the standard fashion using a running 5/0 prolene suture (Fig. 4). The postoperative course was uneventful. The patient was discharged on the fourth postoperative day. The patient was well at the 25-month follow-up.

Aortic aneurysm formation following coarctation repair by Dacron patch aortoplasty

We describe the finding of an aortic aneurysm in an asymptomatic 43-year-old male, who was managed by Dacron patch aortoplasty for native coarctation of the aorta 25 years before. The role of magnetic resonance angiography as standard imaging technique in lifelong postoperative surveillance is discussed subsequently. (Neth Heart J 2010;18:376-7.).

Giant Aneurysm After Aortic Coarctation: Repair without Circulatory Arrest

We describe the case of a 23-year-old patient presenting for redo aortic arch surgery because of recoarctation and poststenotic aneurysm formation after patch aortoplasty in infancy. Using the hemi-clamshell approach, the entire aortic arch was replaced and the supraaortic branches were reimplanted. The applied surgical technique using hypothermic extracorporeal circulation without cardiac arrest allowed an uninterrupted cerebral and spinal cord perfusion due to stepwise clamping of the aortic arch during reconstruction and resulted in an excellent neurologic outcome at six-month follow-up.

Risk factors for recoarctation and results of reoperation: a 40-year review.

We analyzed a single institution 40-year experience with children that had coarctation repair to define risk factors for recoarctation and to evaluate the results of reoperation for recoarctation. Between 1957 and 1998, 271 patients had primary surgical repair of coarctation of the aorta. Techniques for primary repair included Gore-tex patch aortoplasty (PATCH; n = 118), resection with extended end-to-end anastomosis (RXEEA; n = 69), subclavian flap aortoplasty (SFA; n = 61), resection with simple end-to-end anastomosis (ETE; n = 18), resection and interposition graft (n = 4), and extra-anatomic graft (n = 1). Techniques for recoarctation repair included PATCH, interposition graft, and extra-anatomic graft. Median age at initial repair was 156 days. Major associated cardiac anomalies were present in 96 patients (35%). A hypoplastic aortic arch was present in 37 patients (14%). There were three early deaths (1%) and six late deaths (2%). One patient had paraplegia (0.4%). Recoarctation occurred in 29 patients (11%) and was most frequent with ETE and SFA repairs (33% and 20%, respectively). Multiple logistic regression analysis revealed ETE repair (p = 0.0002), SFA repair (p = 0.049), and aortic arch hypoplasia (p = 0.0001) to be risk factors for recoarctation. Using PATCH as the covariate, the odds ratio to develop recoarctation was 3.5 for SFA, 17.2 for ETE, and 15.2 for hypoplastic aortic arch. There was no mortality or paraplegia after recoarctation repair (n = 23). Six patients had seven balloon angioplasties; two of these patients later required reoperation. Three patients required a second reoperation for persistent coarctation. In our 40-year review, simple end-to-end anastomosis and subclavian flap repair had the highest incidence of recoarctation, especially when associated with aortic arch hypoplasia. We recommend resection with extended end-to-end anastomosis for repair of neonates and infants and Gore-tex patch aortoplasty for children over the age of 1 year. Surgical repair of recurrent coarctation is safe, effective, and has a low incidence of persistent coarctation.

Coronary artery bypass surgery in the second decade of life

Familial hypercholesterolemia (FH) is an autosomal dominant disorder of lipid metabolism. These patients develop coronary artery disease in the second or third decade of life, but patients requiring a coronary artery bypass in the second decade of life is rare. We report our experience with management of two patients with FH who presented to us in the second decade of life. Both patients required a coronary artery bypass grafting. The second patient underwent a patch aortoplasty for supra valvar aortic stenosis along with a coronary artery bypass.

An unusual cause of acute cholangitis†

An 84-year-old woman with a history of a 4-cm abdominal aortic aneurysm presented with fever, chills, nausea, and right upper quadrant abdominal pain for 12 hours. Pertinent physical findings included a fever of 39.4°C, pulse of 120-130, and marked right upper quadrant tenderness with mild guarding but no rebound tenderness or palpable abdominal pulsatile mass. Laboratory analyses revealed elevated total bilirubin of 1.9 mg/dL (normal = 0.2-1.0 mg/dL), with direct bilirubin of 1.6 mg/dL (normal = 0.0-0.3 mg/dL), an elevated aspartate aminotransferase of 760 U/L (normal = 7-45 U/L), leukocytosis of 14,300 cells/μL (normal <11,000 cells/μL) and microcytic anemia with a hemoglobin of 10 g/dL (normal = 12-16 g/dL), hematocrit of 31% (normal = 38%-46%), and mean corpuscular volume of 78 fL (normal = 80-100 fL). ERCP, endoscopic retrograde cholangiopancreatography; MRCP, magnetic resonance cholangiopancreatography. Magnetic resonance cholangiopancreatography (MRCP) revealed a 1-cm dilated common bile duct tightly wrapped around a 5.8-cm abdominal aortic aneurysm with a thrombus (Fig. 1) causing extrahepatic bile duct compression and associated proximal bile duct dilatation without signs of choledocholithiasis (Fig. 2). The patient declined any surgery or other invasive procedures and was managed conservatively with antibiotics and pain control. Her symptoms initially improved, but she subsequently developed septic shock and died. Acute cholangitis is a bacterial infection typically superimposed on an obstruction of the biliary tree, usually caused by choledocholithiasis. The differential diagnosis also includes inflammatory biliary stricture caused by primary sclerosing cholangitis, obstructive tumors such as cholangiocarcinoma and ampullary neoplasm, biliary stenosis due to pancreatic pathology, iatrogenic endoscopic manipulation of the common bile duct and extrahepatic bile duct compression. There are a number of less common but important causes of cholangitis. Common bile duct stenosis has been caused by calcified, dissecting, and ruptured abdominal aortic aneurysms, abdominal aortic pseudoaneurysms and aneurysms of the celiac axis and hepatic artery. In previously reported similar cases, the prominent presenting symptom was jaundice, whereas others had abdominal pain, fever, and anorexia.1, 2 Another rare extraluminal source of common bile duct compression is portal hypertension causing dilated portal vein collaterals. In one series of eight cases of biliary obstruction secondary to portal cavernomas, the average time from portal cavernoma diagnosis—usually by ruptured esophageal varice—to biliary involvement was 8 years.3 In another study, the majority of patients with portal biliopathy who presented with acute cholangitis and were diagnosed by abdominal ultrasound with doppler and endoscopic retrograde cholangiopancreatography (ERCP).4 Elimination of biliary obstruction is critical for survival and includes endoscopic sphincterotomy and balloon endoscopic dilatation of the common bile duct as well as surgical decompression of the portal system with splenorenal shunting. This case demonstrates the importance of appropriate imaging such as MRCP to both accurately diagnose the cause of cholangitis and to guide definitive therapy to relieve biliary obstruction in patients with vascular and other anatomical anomalies. MRCP is an accurate and noninvasive tool for investigation of the pancreatico-biliary tree. It is more cost-effective than ERCP, has the ability to diagnose extrahepatic compression, and is far more sensitive than traditional ultrasound.5 Such cases should be initially treated with urgent biliary decompression and stent insertion for drainage. After resolution of infection, treatment options include repair of aneurysm by intraluminal patch aortoplasty and surgical exclusion of the aneurysm by ligation to address the underlying cause of the obstruction and prevent future complications.

Role of endovascular repair in the management of late pseudo-aneurysms following open surgery for aortic coarctation

Coarctation of the aorta accounts for almost 5% of all congenital cardiac malformations, and it is usually treated by open surgical procedures. Despite the excellent primary results, many patients may develop anastomotic pseudo-aneurysms, associated with considerable morbidity and mortality rates. We investigated the role of endovascular repair as an alternative to open re-do surgery on the descending aorta. We retrospectively collected data of 11 consecutive patients who presented with pseudo-aneurysms of the descending aorta following previous surgical repair of congenital aortic coarctation. Nine patients developed a pseudo-aneurysm after patch aortoplasty, while an interposition graft repair was performed in two cases. Seven patients underwent an endovascular repair (26.9 years after the previous open surgery). Four patients with a pseudo-aneurysm after coarctation repair associated with arch hypoplasia underwent conventional open re-operation. No complications or death were observed in the conventional surgical group. Technical success was obtained in all patients who received a stent-graft procedure. More than one stent graft was necessary only in one case. A left carotid-left subclavian artery bypass was performed in three patients. Type II endoleak was detected by angiography in one patient who had previously undergone subclavian re-vascularisation. The median follow-up (FU) was 44.5 months and was 100% complete. Neither re-operations nor complications or deaths occurred during FU. Endovascular repair of pseudo-aneurysms following open surgery for aortic coarctation is feasible and safe. However, more patients and longer follow-up are necessary to assess the efficacy of this promising less-invasive alternative to open re-do surgery.