Article Text

Covered stent to treat co-existent coarctation and aneurysm of the aorta in a young man
  1. JULIAN GUNN,
  2. TREVOR CLEVELAND,
  3. PETER GAINES

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    A 23 year old man presented with hypertension and clinical, electrocardiographic, echocardiographic, and radiographic features of coarctation. Aortography delineated the coarctation (gradient 40 mm Hg) and a spherical aneurysm 3 cm across, originating at the coarctation. Under general anaesthesia, a cut-down and femoral arteriotomy was made and a 16 F sheath inserted. A superstiff Amplatz 0.035 inch guidewire was advanced across the coarctation. A 37.5 mm long (maximum diameter 22 mm) AneuRx (Medtronic, Watford, UK) self expanding, Nitinol mesh stent, covered with a stretchable polytetrafluoroethane membrane, was placed across both the coarctation and the neck of the aneurysm under fluoroscopic guidance. Serial dilatation was made with 12 × 40 mm and 15 × 40 mm balloons (Cordis, Ascot, UK). Balloon dilatation alone was rejected because of the danger of rupture of the aneurysm. A conventional, uncovered stent might have “splinted open” a dissection plane or failed to seal off the aneurysm. With the covered stent, care had to be taken to avoid the left subclavian artery, thereby avoiding any danger of embolising the vertebral circulation. The flexible nature of this stent graft, in contrast to slotted tube designs, suited the curve of the aorta. The final appearance of the stented segment was smooth and patent, with a minimal residual pressure gradient and exclusion of the aneurysm. The temptation to pursue an angiographically wider lumen was resisted because the gradient had been largely abolished and because of the risk of graft rupture. Computed tomography 24 hours later confirmed persisting exclusion of the aneurysm. Six months later, the patient was well with a blood pressure of 120/80 mm Hg.

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