Repair of aortic coarctation has traditionally been based on surgical methods although catheter interventions are progressively improving [3]. Different surgical approaches including resection with end-to-end anastomosis, direct aortoplasty using transverse suture repair, patch-graft aortoplasty, subclavian flap aortoplasty, and resection with end-to-end conduit interposition are used for surgical correction. In spite of successful repair of coarctation, postsurgical patients are still at risk of long-term complications including recurrence of the aortic coarctation and true or false aortic aneurysm formation with risk of dissection, rupture, or fistulization to adjacent structures. Although aneurysm formation at the site of repair is relatively more common after patch graft aortoplasty it is seen following other approaches including bypass grafting, end-to-end anastomosis, or subclavian flap aortoplasty and even after transcatheter interventions [4]. The aneurysm usually develops as a result of a more flexible vessel wall compared to the patch, long-lasting hypertension, or extreme resections of the aortic rim [3]. Hence, to protect patients against complicated aneurysms, we need to identify them early by regular follow-up imaging. Relatively high mortality and morbidity is seen with the repeat surgical repair of postsurgical complications, and the best management strategy has yet to be established .Reoperation following previous patch-graft aortoplasty is reported to have a 14% mortality rate and substantial morbidity, including paraplegia and bleeding complications [5]. In addition, patients often prefer minimally invasive options.
Although endovascular stent grafting has been approached cautiously in the treatment of such young patients, newer stent graft designs offer better conformability and durability, and endovascular stent grafting could be considered as a safe option for treatment of these patients. Advantages of stent grafts include the fact that they could cover the total length of the diseased aorta. However, long-term efficacy and freedom of reintervention remain to be investigated.
Yazar et al. in their series of 13 patients with TEVAR for treatment of late complications after aortic coarctation reported cases suffering mortality and morbidity [6]. Lala et al. reported 21 adult patients with primary coarctation or post repair complications, four of whom had pseudoaneurysm and were treated with TEVAR, with acceptable results and no mortality. However, there were cases with reported endoleaks and patients requiring reinterventions during their 8 months of follow-up [7]. Erben et al. also reported 11 patients with postoperative aneurysm/pseudoaneurysm in their case series, all of whom were treated with stent grafts. Four patients needed concomitant left carotid to left subclavian artery bypass and two a right carotid to left carotid to left subclavian artery bypass [8]. Our patient had the left subclavian artery prophylactically occluded to avoid the risk of endoleak. As the patient did not develop upper extremity claudication, there was no need for left subclavian bypass grafting.