3|Discussion
While surgery repair remains the first choice of treatment for
coarctation of the aorta in infant and children, endovascular approaches
like balloon angioplasty and stenting are increasingly employed in adult
patients [4]. However, we did not recommend endovascular treatment
for several reasons in this patient. Firstly, the patient’s twisted
artery presented challenges in advancing a flexible guidewire across the
coarctation. Secondly, this case involved not only aortic coarctation
but also a concurrent aortic arch aneurysm, elevating the risk of
rupture. Additionally, to minimize bleeding and maintain lower body
blood supply, we opted for an extra-anatomical bypass instead of
excising the coarctation and performing an end-to-end anastomosis.
Since Crafoord first surgical intervention to correct aortic coarctation
in 1944[5], there have been significant advancements in surgical
techniques, enhancing treatment quality and patient outcomes. Despite
reduced mortality and morbidity rates, surgeries for aortic coarctation
still pose considerable risks, including adverse events and patient
morbidity. The presence of a concomitant aortic arch aneurysm in
patients with aortic coarctation is exceedingly rare. Therefore,
individualized patient assessments and meticulous planning are
imperative for determining the most appropriate treatment strategy
before undertaking such high-risk surgeries.
A major advantage of the extra-anatomic surgical approach is the
durability in providing substantial distal blood flow to the mesentery
and lower extremities. In a single-institution series of 50 patients
undergoing ascending-descending aortic bypass for coarctation, there was
no incidences of graft occlusion or pseudoaneurysm formation over an
average follow-up of 33 months, with imaging evaluations conducted on
74% of the grafts[6].