ENDOVASCULAR REPAIR OF POST-COARCTATION LESIONS IN THE DESCENDING THORACIC AORTA

Aims. We report on two cases of aneurysm of the descending thoracic aorta (DTA) secondary to aortic coarctation (AC) which were treated using endovascular techniques. Case reports. Case 1: a 28-year-old male who underwent an intervention to correct AC at the age of 3 months (coarctectomy with end-to-end anastomosis) and was submitted to surgery again at the age of 8 years (Dacron patch aortoplasty); there was a 60 mm dilatation of the area of the previous intervention with involvement of the exit point of the left subclavian artery (LSA), with a transaortic gradient of 21 mmHg. The patient required the placement of a carotid-subclavian bypass before aneurysmal repair, and later two overlapping 26 x 130 mm and 30 x 36 x 115 mm Talent-type stent grafts were implanted. Case 2: a 35-year-old female with no history of relevant clinical events, who had a 42 x 39 mm aneurysm of the DTA 16 mm from the exit point of the LSA; the patient was a carrier of AC with a transaortic gradient of 28 mmHg. A 32 x 130 mm Talenttype aortic stent graft with a non-covered proximal end was placed in the aortic arch proximal to the LSA, without occluding the exit of the supra-aortic trunks, and with the association of balloon dilatation of the stenotic region that remained from the coarctation. In both cases the aneurysms of the DTA were totally excluded, with no leaks that could be verified angiographically or topographically, and with no residual transaortic gradients. Results in the clinical control at 24 and 18 months showed that the patients are asymptomatic, with a thrombosed aneurysmal sac and absence of leaks. Conclusions. Despite the fact that the performance of the materials and the long-term duration of stent grafts in current use are unknown, the endovascular procedure may become the preferred technique in a substantial number of patients with a pathological condition affecting the descending thoracic aorta.