Multicenter experience with endovascular treatment of aortic coarctation in adults
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Multicenter experience with endovascular treatment of aortic coarctation in adults. / Erben, Young; Oderich, Gustavo S; Verhagen, Hence J M; Witsenburg, Maarten; van den Hoven, Allard T; Debus, Eike S; Kölbel, Tilo; Arko, Frank R; Torsello, Giovanni B; Torsello, Giovanni F; Lawrence, Peter F; Harlander-Locke, Michael P; Bacharach, J Michael; Jordan, William D; Eskandari, Mark K; Hagler, Donald J.
In: J VASC SURG, Vol. 69, No. 3, 03.2019, p. 671-679.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Multicenter experience with endovascular treatment of aortic coarctation in adults
AU - Erben, Young
AU - Oderich, Gustavo S
AU - Verhagen, Hence J M
AU - Witsenburg, Maarten
AU - van den Hoven, Allard T
AU - Debus, Eike S
AU - Kölbel, Tilo
AU - Arko, Frank R
AU - Torsello, Giovanni B
AU - Torsello, Giovanni F
AU - Lawrence, Peter F
AU - Harlander-Locke, Michael P
AU - Bacharach, J Michael
AU - Jordan, William D
AU - Eskandari, Mark K
AU - Hagler, Donald J
N1 - Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
PY - 2019/3
Y1 - 2019/3
N2 - OBJECTIVE: The objective of this study was to evaluate outcomes of endovascular treatment of aortic coarctation in adults.METHODS: Clinical data and imaging studies of 93 consecutive patients treated at nine institutions from 1999 to 2015 were reviewed. We included newly diagnosed aortic coarctation (NCO), recurrent coarctation, and aneurysmal/pseudoaneurysmal degeneration (ANE) after prior open surgical repair (OSR) of coarctation. Primary end points were morbidity and mortality. Secondary end points were stent patency and freedom from reintervention.RESULTS: There were 54 (58%) male and 39 (42%) female patients with a mean age of 44 ± 17 years. Thirty-two patients had NCO (mean age, 48 ± 16 years) and 61 had endovascular reinterventions after prior OSR during childhood (mean, 30 ± 17 years after initial repair), including 50 patients (54%) with recurrent coarctation and 11 (12%) with ANE. Clinical presentation included asymptomatic in 31 patients (33%), difficult to control hypertension in 42 (45%), and lower extremity claudication in 20 (22%). Endovascular treatment was performed using balloon-expandable covered stents in 47 (51%) patients, stent grafts in 36 (39%) patients, balloon-expandable uncovered stents in 9 (10%) patients, and primary angioplasty in 1 (1%) patient. Mean lesion length and diameter were 64.5 ± 50.6 mm and 19.5 ± 6.7 mm, respectively. Mean systolic pressure gradient decreased from 24.0 ± 17.5 mm Hg to 4.4 ± 7.4 mm Hg after treatment (P < .001). Complications occurred in nine (10%) patients, including aortic dissections in three (3%) patients and intraoperative ruptures in two patients; type IA endoleak, renal embolus, spinal headache, and access site hemorrhage occurred in one patient each. The aortic dissections and ruptures were treated successfully by deploying an additional covered stent proximal to the site of dissection or rupture. Two patients died within 30 days of the index procedure. After a mean follow-up of 3.2 ± 3.1 years, nearly all patients (98%) were clinically improved and all stents were patent. Reintervention was needed in 10 (11%) patients. Freedom from reintervention at 5 years was 85%. Two additional patients died during follow-up of coarctation-related causes, including rupture of an infected graft and visceral ischemia. Patient survival at 5 years was 89%.CONCLUSIONS: Endovascular repair is effective with an acceptable safety profile in the treatment of NCO and postsurgical complications of coarctation after initial OSR. Aortic rupture is an infrequent (2%) but devastating complication with high mortality. Balloon-expandable covered stents are preferred for NCO, whereas stent grafts are used for ANE. The rate of reinterventions is acceptable, with high procedural and long-term clinical success.
AB - OBJECTIVE: The objective of this study was to evaluate outcomes of endovascular treatment of aortic coarctation in adults.METHODS: Clinical data and imaging studies of 93 consecutive patients treated at nine institutions from 1999 to 2015 were reviewed. We included newly diagnosed aortic coarctation (NCO), recurrent coarctation, and aneurysmal/pseudoaneurysmal degeneration (ANE) after prior open surgical repair (OSR) of coarctation. Primary end points were morbidity and mortality. Secondary end points were stent patency and freedom from reintervention.RESULTS: There were 54 (58%) male and 39 (42%) female patients with a mean age of 44 ± 17 years. Thirty-two patients had NCO (mean age, 48 ± 16 years) and 61 had endovascular reinterventions after prior OSR during childhood (mean, 30 ± 17 years after initial repair), including 50 patients (54%) with recurrent coarctation and 11 (12%) with ANE. Clinical presentation included asymptomatic in 31 patients (33%), difficult to control hypertension in 42 (45%), and lower extremity claudication in 20 (22%). Endovascular treatment was performed using balloon-expandable covered stents in 47 (51%) patients, stent grafts in 36 (39%) patients, balloon-expandable uncovered stents in 9 (10%) patients, and primary angioplasty in 1 (1%) patient. Mean lesion length and diameter were 64.5 ± 50.6 mm and 19.5 ± 6.7 mm, respectively. Mean systolic pressure gradient decreased from 24.0 ± 17.5 mm Hg to 4.4 ± 7.4 mm Hg after treatment (P < .001). Complications occurred in nine (10%) patients, including aortic dissections in three (3%) patients and intraoperative ruptures in two patients; type IA endoleak, renal embolus, spinal headache, and access site hemorrhage occurred in one patient each. The aortic dissections and ruptures were treated successfully by deploying an additional covered stent proximal to the site of dissection or rupture. Two patients died within 30 days of the index procedure. After a mean follow-up of 3.2 ± 3.1 years, nearly all patients (98%) were clinically improved and all stents were patent. Reintervention was needed in 10 (11%) patients. Freedom from reintervention at 5 years was 85%. Two additional patients died during follow-up of coarctation-related causes, including rupture of an infected graft and visceral ischemia. Patient survival at 5 years was 89%.CONCLUSIONS: Endovascular repair is effective with an acceptable safety profile in the treatment of NCO and postsurgical complications of coarctation after initial OSR. Aortic rupture is an infrequent (2%) but devastating complication with high mortality. Balloon-expandable covered stents are preferred for NCO, whereas stent grafts are used for ANE. The rate of reinterventions is acceptable, with high procedural and long-term clinical success.
KW - Adult
KW - Aged
KW - Angioplasty, Balloon/adverse effects
KW - Aortic Coarctation/diagnostic imaging
KW - Blood Vessel Prosthesis
KW - Blood Vessel Prosthesis Implantation/adverse effects
KW - Female
KW - Graft Occlusion, Vascular/etiology
KW - Humans
KW - Male
KW - Middle Aged
KW - Progression-Free Survival
KW - Recurrence
KW - Retreatment
KW - Retrospective Studies
KW - Risk Assessment
KW - Risk Factors
KW - Stents
KW - Time Factors
KW - Vascular Patency
KW - Young Adult
U2 - 10.1016/j.jvs.2018.06.209
DO - 10.1016/j.jvs.2018.06.209
M3 - SCORING: Journal article
C2 - 30528403
VL - 69
SP - 671
EP - 679
JO - J VASC SURG
JF - J VASC SURG
SN - 0741-5214
IS - 3
ER -
