Primary Thoracic Aortic Coarctation in Adults: Endovascular Treatment with Thoracic Covered Stents

Abstract

OBJECTIVE: Primary aortic coarctation (PAC) has been successfully managed in younger patients with uncovered stents. We describe the use of covered thoracic stents to successfully manage PAC diagnosed in adults.

METHODS: From 2010-2014, nine previously undiagnosed primary thoracic aortic coarctations were identified at five centers.  Endovascular management was undertaken using covered thoracic stents (CTAG, W.L. Gore & Associates, Flagstaff, AZ) by themselves or in combination with abdominal aortic extension cuffs (Excluder Extension Cuffs, W.L. Gore & Associates, Flagstaff, AZ).  In addition to demographics, endpoints evaluated in this retrospective review included operative details, procedural complications and follow up. 

RESULTS:  Four patients presented with asymptomatic upper extremity hypertension while five patients presented with cerebral (1), colonic (2) or lower extremity (2) ischemia.  The median age at diagnosis was 55 (range 27-76).  All nine patients (5 females/4males) were successfully treated using covered stents.  There were no perioperative complications including death, spinal cord ischemia, or vascular access morbidity.  Average length of stay was 3 days (range 2-5).  Vascular access was obtained utilizing a femoral cut down in all patients.  Graft deployment was facilitated using 30mg of adenosine in four patients.   Pre deployment balloon angioplasty was not performed; however, all grafts were dilated post deployment.  Mean preoperative gradient across the coarctation was 65mm (range 42-82mm) which was reduced to zero in all cases following stenting.  Average follow up was 3.2 (range 2-6 years) years without evidence of recurrence.  

CONCLUSION: The use of covered thoracic stents for the primary treatment of coarctation of the descending thoracic aorta is feasible and offers a potential alternative to open surgical repair.