Treatment of Aortic Coarctation by Self-expanding Thoracic Endograft with Left Subclavian In Situ Laser Fenestration

TY - JOUR

T1 - Treatment of Aortic Coarctation by Self-expanding Thoracic Endograft with Left Subclavian In Situ Laser Fenestration

AU - Law, Yuk

AU - Tsilimparis, Nikolaos

AU - Aleed, Shadi

AU - Rohlffs, Fiona

AU - Schofer, Niklas

AU - Debus, Eike S

AU - Müller, Goetz

AU - Kölbel, Tilo

N1 - Copyright © 2018 Elsevier Inc. All rights reserved.

PY - 2019/4

Y1 - 2019/4

N2 - BACKGROUND: Thoracic endovascular aortic repair (TEVAR) with self-expanding endograft is increasingly used as a viable treatment option for adult aortic coarctation (AC).METHODS: We hereby reported a 55-year-old gentleman with late presentation of AC, treated by a novel strategy with thoracic endograft and in situ laser fenestration for left subclavian artery (LSA) revascularization.RESULTS: AC was incidentally discovered during coronary angiogram as an investigation for his angina pectoris. TEVAR with self-expanding endograft was chosen because preoperative computer tomography scan showed ectatic thoracic aorta and stenosis just distal to the LSA. The patient was planned for a timely second-stage aortic valve replacement and coronary artery bypass grafting using left internal mammary artery shortly after TEVAR, which required a patent LSA. The procedure was arranged semiurgently. A 34-mm thoracic tube endograft was placed across the coarctation with proximal landing distal to the left common carotid artery. In situ fenestration was created by laser catheter through retrograde left brachial access. The fenestration was then enlarged by balloon dilatation and bridged to the left subclavian origin with a 16-mm balloon-expandable covered stent.CONCLUSIONS: TEVAR with in situ fenestration for LSA is a reliable choice for adult AC. The technique added to the armamentarium of treatment options.

AB - BACKGROUND: Thoracic endovascular aortic repair (TEVAR) with self-expanding endograft is increasingly used as a viable treatment option for adult aortic coarctation (AC).METHODS: We hereby reported a 55-year-old gentleman with late presentation of AC, treated by a novel strategy with thoracic endograft and in situ laser fenestration for left subclavian artery (LSA) revascularization.RESULTS: AC was incidentally discovered during coronary angiogram as an investigation for his angina pectoris. TEVAR with self-expanding endograft was chosen because preoperative computer tomography scan showed ectatic thoracic aorta and stenosis just distal to the LSA. The patient was planned for a timely second-stage aortic valve replacement and coronary artery bypass grafting using left internal mammary artery shortly after TEVAR, which required a patent LSA. The procedure was arranged semiurgently. A 34-mm thoracic tube endograft was placed across the coarctation with proximal landing distal to the left common carotid artery. In situ fenestration was created by laser catheter through retrograde left brachial access. The fenestration was then enlarged by balloon dilatation and bridged to the left subclavian origin with a 16-mm balloon-expandable covered stent.CONCLUSIONS: TEVAR with in situ fenestration for LSA is a reliable choice for adult AC. The technique added to the armamentarium of treatment options.

KW - Angioplasty, Balloon/instrumentation

KW - Aorta, Thoracic/diagnostic imaging

KW - Aortic Coarctation/diagnostic imaging

KW - Aortography/methods

KW - Blood Vessel Prosthesis

KW - Blood Vessel Prosthesis Implantation/instrumentation

KW - Computed Tomography Angiography

KW - Humans

KW - Laser Therapy

KW - Male

KW - Middle Aged

KW - Prosthesis Design

KW - Stents

KW - Subclavian Artery/diagnostic imaging

KW - Treatment Outcome

U2 - 10.1016/j.avsg.2018.07.068

DO - 10.1016/j.avsg.2018.07.068

M3 - SCORING: Journal article

C2 - 30342211

VL - 56

SP - 350.e9-350.e13

JO - ANN VASC SURG

JF - ANN VASC SURG

SN - 0890-5096

ER -