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A Novel Approach for the Endovascular Repair of the Small Thoracic Aorta: Customizing Off-the-Shelf Endoluminal Grafts to Treat a Post-Coarctation Pseudoaneurysm

https://doi.org/10.1016/j.athoracsur.2007.04.120Get rights and content

Surgical repair of post-coarctation pseudoaneurysm is associated with high morbidity and mortality. Endovascular stent grafting is a minimally invasive approach to manage this condition. The small thoracic aorta provides a dilemma for endovascular stent grafting using available commercially available thoracic endografts. We describe a hybrid approach including a novel technique to customize various components of the abdominal endoluminal grafts to repair a post-coarctation pseudoaneurysm. The patient is doing well at 1-year follow-up with no endoleaks.

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Technique

A left carotid subclavian artery bypass was performed the day prior to the endovascular procedure, because the pseudoaneurysm involved the left subclavian artery as demonstrated in Figure 2. Percutaneous access of the left common femoral artery was performed with a 9-French sheath that was introduced. Thoracic arch aortogram was performed through the left sheath with a pigtail catheter to delineate the arch and descending thoracic aorta and aneurysm. An intravascular ultrasound was performed

Comment

This case represents a novel approach of customizing off-the-shelf endovascular components for the small thoracic aorta. Until thoracic endoprostheses are developed that are smaller in diameter, this customized approach is the best solution when an endovascular approach is contemplated. Severe adult type coarctation accounts for 4% of congenital cardiovascular malformations, which are usually surgically corrected.

Stent graft repair of thoracic aneurysm has been shown to be feasible with

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