Ann Thorac Surg 2008;85:2142. doi:10.1016/j.athoracsur.2007.08.013
© 2008 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Aortic Coarctation Secondary to In-Stent Stenosis of a Covered Aortic Endoprosthesis
Enoch Akowuah, MD, MRCSa,
Peter Wilde, FRCR, MRCPb,
Alan J. Bryan, DM, FRCS(CTh)a,*
a Department of Cardiothoracic Surgery, Bristol Heart Institute at the Bristol Royal Infirmary, Bristol, United Kingdom
b Department of Cardiology, Bristol Heart Institute at the Bristol Royal Infirmary, Bristol, United Kingdom
* Address correspondence to Dr Bryan, Bristol Heart Institute, Bristol Royal Infirmary, Upper Maudlin St, Bristol, BS2 8HN, United Kingdom (Email: alan.bryan{at}ubht.swest.nhs.uk).
The use of covered endovascular stents to treat a variety of thoracic aortic pathology is well established. Although technical feasibility and medium efficacy have been demonstrated, there is little data regarding possible long-term complications.
A 27-year-old man involved in a road traffic accident was diagnosed with traumatic aortic rupture at the aortic isthmus. Emergency endovascular repair was successfully performed using a 26-mm Talent stent (Medtronic, Minneapolis, MN). An excellent result was achieved (Fig 1).
Two years later he represented with upper body hypertension, symptoms of heart failure, and a clinical picture consistent with a coarctation of the aorta. An aortogram revealed narrowing at the distal end of the original stent and a filling defect (Fig 2). This was treated by the insertion of an uncovered stent within the original covered stent (Fig 3). The patient had a gradual resolution of symptoms and has had no further complications to date.
The stenosis within the original stent appeared to be caused by in-growth of material from within the stent itself. There was no evidence of structural disintegration of the stent.
Recent long-term results of endovascular stenting of the abdominal aorta demonstrate a high rate of late complications (ie, approximately 50% of patients during an 8-year period) [1]. Close follow-up of patients receiving a thoracic aortic stent is mandatory in the long term, as similarly high complication rates may be observed.
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References
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- Leurs LJ, Buth J, Laheij RJ. Long-term results of endovascular abdominal aortic aneurysm treatment with the first generation of commercially available stent grafts Arch Surg 2007;142:33-41.[Abstract/Free Full Text]
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