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Endovascular Treatments for Coarctation of the Aorta with Concurrent Poststenotic Aneurysms in Adults

  • Jun Pan
    Affiliations
    Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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  • Yongchang Liu
    Affiliations
    Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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  • Yangyan He
    Affiliations
    Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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  • Xiaohui Wang
    Affiliations
    Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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  • Lu Tian
    Affiliations
    Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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  • Jieqiong Wang
    Affiliations
    Department of Operating room, Affiliated Hangzhou First People's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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  • Xin Fang
    Affiliations
    Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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  • Hongkun Zhang
    Correspondence
    Correspondence to: Chenyang Qiu, MD, Ziheng Wu, MD, Hongkun Zhang, MD, Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No.79 Qingchun Road, Shangcheng District, Hangzhou, Zhejiang, China 310003
    Affiliations
    Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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  • Ziheng Wu
    Correspondence
    Correspondence to: Chenyang Qiu, MD, Ziheng Wu, MD, Hongkun Zhang, MD, Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No.79 Qingchun Road, Shangcheng District, Hangzhou, Zhejiang, China 310003
    Affiliations
    Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
    Search for articles by this author
  • Chenyang Qiu
    Correspondence
    Correspondence to: Chenyang Qiu, MD, Ziheng Wu, MD, Hongkun Zhang, MD, Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No.79 Qingchun Road, Shangcheng District, Hangzhou, Zhejiang, China 310003
    Affiliations
    Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
    Search for articles by this author

      Highlights

      • This study is a two-center retrospective cohort study.
      • We used stent grafts to treat coarctation of the aorta CoA with poststenotic aneurysms in 15 patients.
      • Endovascular treatment restored normal flow of aorta and excluded aneurysms simultaneously.
      • At the mean follow-up of 55 months, results were satisfactory.

      Background

      Coarctation of the aorta with poststenotic aneurysms is rare and complex. Here we report a relatively large group of endovascular treatments for the disease.

      Materials and Methods

      Fifteen patients from two centers between 2006 and 2019 were included in the study. The patients were retrospectively divided into two groups. Patients in the complex group had insufficient proximal landing zone (<2 cm) or the zigzag shape of aorta. Their demographics, clinical manifestations, endovascular procedures, and follow-up results were analyzed.

      Results

      There were 7 patients in the simple group and 8 patients in the complex group. Eleven patients were symptomatic. Despite the unfavorable anatomy in the complex group, technical success reached 100%. The diameter of coarctation increased from 8.6 mm to 16.7 mm with poststenotic aneurysms successfully excluded at the same time. In patients without sufficient proximal landing zone, left subclavian artery was covered by the stent grafts and then sacrificed (three patients) or revascularized (four patients). Other than one patient who suffered iliac artery rupture and received open repair, there was no other perioperative complications. Computed tomography angiography repeated at mean 42 months postoperation confirmed patency of stents and the exclusion of aneurysms with no aortic wall injury. Mild endoleaks occurred in two patients in the complex group and were left to observation. During 55.0 months follow-up, except for one patient who received secondary left subclavian artery fenestration, all other patients remained asymptomatic.

      Conclusions

      Endovascular treatments for coarctation of the aorta with poststenotic aneurysm showed a high technical success and could be an alternative solution for such disease.
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