Thorac Cardiovasc Surg 2023; 71(S 01): S1-S72
DOI: 10.1055/s-0043-1761642
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Use of Custom-Made and Parallel Endografts with Debranching Procedures for the Treatment of Pseudoaneurysms after Coarctation Surgery

Authors

  • R. Berger

    1   Department of Thoracic and Cardiovascular Surgery, Tübingen, Deutschland

  • M. Lescan

    1   Department of Thoracic and Cardiovascular Surgery, Tübingen, Deutschland

  • M. Andic

    1   Department of Thoracic and Cardiovascular Surgery, Tübingen, Deutschland

  • C. Schlensak

    1   Department of Thoracic and Cardiovascular Surgery, Tübingen, Deutschland

  • M. Mustafi

    1   Department of Thoracic and Cardiovascular Surgery, Tübingen, Deutschland
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    Background: Pseudoaneurysms may occur at the site of coarctation (CoA) surgery of the aorta. Thoracic endovascular repair (TEVAR) with commercially available endografts is challenging due to the involvement of the left subclavian artery (LSA), proximity to the left carotid commune artery (LCCA), severe arch angulation, and proximal to distal diameter mismatch. The alternative techniques develop.

    Method: We present a single-center retrospective case analysis of six patients treated with endovascular techniques between 2016 and 2021.

    Results: Four men and two women presented with pseudoaneurysms after mean time of 28.5 (± 12.6) years after coarctation surgery: four patch repairs, one subclavian flap, and one Dacron interposition. The mean age was 44.4 (± 16.7) years. One patient was symptomatic with hemoptoe. The endograft treatment included three custom-made endografts (one proximal fenestration for the LSA, all reversed tapered) and three commercially available endografts, of whom one with parallel periscope graft to the LSA. In four cases, the LSA was revascularized with a LCCA-LSA bypass. Vascular plug was used to occlude the involved LSA. Technical and clinical success was achieved in all cases with no mortality, morbidity, endoleaks or complications after a mean follow-up of 40 (range: 12.1–49.5) months. In four patients, pseudoaneurysm shrinkage was observed at the follow-ups and one complete resolution.

    Conclusion: Redo open surgery is challenging because of adhesions of the thoracic cavity and associated morbidity and mortality. TEVAR is less invasive and offers fewer complications. Custom-made modifications and patient adjusted therapy overcome difficult anatomies including short landing zones and proximal to distal diameter mismatch.


     

    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    28 January 2023

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