Dramatic course of unusual remote complication of surgical aorta coarctation repair treated with endovascular methods

Coarctation of the aorta (CoA) is a discrete narrowing in the aortic arch causing obstruction to the flow of blood. Untreated CoA carries a poor prognosis with average survival between 30 and 40 years of age and 75% mortality by 46 years of age [1]. The types of surgical repair include: resection with end-to-end anastomosis with or without graft interposition, patch aortoplasty, bypass procedure or subclavian flap aortoplasty. At present, no single treatment modality appears to have a clear superiority. Since the late 1970s authors have reported remote complications of the repair including aneurysm and pseudo-aneurysms formation, aortic recoarctation (ReCoA) or dissection. Studies showed a considerable increase of late morbidity among patients who underwent this procedure [2, 3].
The authors present a dramatic course of unusual aortic damage in a patient with history of surgical repair of CoA over 40 years prior to hospitalization treated with endovascular methods.
A 55-year-old woman was admitted to the Emergency Unit of a district hospital from a wedding complaining of weakness, lower limb paresthesia (she fell while dancing) and abdominal discomfort. The patient reported a history of surgical treatment (lack of medical documentation) due to coarctation of the aorta at the age of 8 years and percutaneous closure of atrial septal defect (ASD) with an Amplatzer Septal Occluder 1 year prior to the current hospitalization. After several hours in the Emergency Unit of a district hospital where she reported the severity of existing complaints and the appearance of new symptoms in the form of abdominal pain and tachypnea she was referred to the Cardiosurgery Department. On admission: tachypnea, paraparesis, abdominal pain, hypoactive bowel sounds and non-palpable peripheral pulse. Blood count revealed critical values of coagulation tests (international normalized ratio (INR) 4.7), signs of renal dysfunction (creatinine – 1.1 mg/dl, estimated glomerular filtration rate (eGFR) – 51 ml/min/1.73 m²) and anemia (hemoglobin (HGB) 10.1 g/dl, red blood cells (RBC) 3.9 × 106/ml). Computed tomography (CT)-angio revealed aortic stenosis below the level of the operated region and probably presence of a thrombus (Figures 1 A–H). The patient was qualified for thoracic stent graft implantation in order to restore aortic flow and cover the thrombus to prevent its migration.
Under all sterile conditions and in general anesthesia the right femoral...


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