Multicenter experience with endovascular treatment of aortic coarctation in adults

Young Erben, Gustavo Oderich, Hence J.M. Verhagen, Maarten Witsenburg, Allard T. van den Hoven, Eike S. Debus, Tilo Kölbel, Frank R. Arko, Giovanni B. Torsello, Giovanni F. Torsello, Peter F. Lawrence, Michael P. Harlander-Locke, J. Michael Bacharach, William D. Jordan, Mark K. Eskandari, Donald J. Hagler

Research output: Contribution to journalArticle

Abstract

Objective: The objective of this study was to evaluate outcomes of endovascular treatment of aortic coarctation in adults. Methods: Clinical data and imaging studies of 93 consecutive patients treated at nine institutions from 1999 to 2015 were reviewed. We included newly diagnosed aortic coarctation (NCO), recurrent coarctation, and aneurysmal/pseudoaneurysmal degeneration (ANE) after prior open surgical repair (OSR) of coarctation. Primary end points were morbidity and mortality. Secondary end points were stent patency and freedom from reintervention. Results: There were 54 (58%) male and 39 (42%) female patients with a mean age of 44 ± 17 years. Thirty-two patients had NCO (mean age, 48 ± 16 years) and 61 had endovascular reinterventions after prior OSR during childhood (mean, 30 ± 17 years after initial repair), including 50 patients (54%) with recurrent coarctation and 11 (12%) with ANE. Clinical presentation included asymptomatic in 31 patients (33%), difficult to control hypertension in 42 (45%), and lower extremity claudication in 20 (22%). Endovascular treatment was performed using balloon-expandable covered stents in 47 (51%) patients, stent grafts in 36 (39%) patients, balloon-expandable uncovered stents in 9 (10%) patients, and primary angioplasty in 1 (1%) patient. Mean lesion length and diameter were 64.5 ± 50.6 mm and 19.5 ± 6.7 mm, respectively. Mean systolic pressure gradient decreased from 24.0 ± 17.5 mm Hg to 4.4 ± 7.4 mm Hg after treatment (P <.001). Complications occurred in nine (10%) patients, including aortic dissections in three (3%) patients and intraoperative ruptures in two patients; type IA endoleak, renal embolus, spinal headache, and access site hemorrhage occurred in one patient each. The aortic dissections and ruptures were treated successfully by deploying an additional covered stent proximal to the site of dissection or rupture. Two patients died within 30 days of the index procedure. After a mean follow-up of 3.2 ± 3.1 years, nearly all patients (98%) were clinically improved and all stents were patent. Reintervention was needed in 10 (11%) patients. Freedom from reintervention at 5 years was 85%. Two additional patients died during follow-up of coarctation-related causes, including rupture of an infected graft and visceral ischemia. Patient survival at 5 years was 89%. Conclusions: Endovascular repair is effective with an acceptable safety profile in the treatment of NCO and postsurgical complications of coarctation after initial OSR. Aortic rupture is an infrequent (2%) but devastating complication with high mortality. Balloon-expandable covered stents are preferred for NCO, whereas stent grafts are used for ANE. The rate of reinterventions is acceptable, with high procedural and long-term clinical success.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Aortic Coarctation
Stents
Therapeutics
Dissection
Rupture
Aortic Rupture
Transplants
Endoleak
Mortality

Keywords

  • Aortic coarctation repair, open and endovascular
  • Congenital coarctation
  • Postcoarctation repair in the adult
  • TEVAR

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Erben, Y., Oderich, G., Verhagen, H. J. M., Witsenburg, M., van den Hoven, A. T., Debus, E. S., ... Hagler, D. J. (Accepted/In press). Multicenter experience with endovascular treatment of aortic coarctation in adults. Journal of Vascular Surgery. https://doi.org/10.1016/j.jvs.2018.06.209

Multicenter experience with endovascular treatment of aortic coarctation in adults. / Erben, Young; Oderich, Gustavo; Verhagen, Hence J.M.; Witsenburg, Maarten; van den Hoven, Allard T.; Debus, Eike S.; Kölbel, Tilo; Arko, Frank R.; Torsello, Giovanni B.; Torsello, Giovanni F.; Lawrence, Peter F.; Harlander-Locke, Michael P.; Bacharach, J. Michael; Jordan, William D.; Eskandari, Mark K.; Hagler, Donald J.

In: Journal of Vascular Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Erben, Y, Oderich, G, Verhagen, HJM, Witsenburg, M, van den Hoven, AT, Debus, ES, Kölbel, T, Arko, FR, Torsello, GB, Torsello, GF, Lawrence, PF, Harlander-Locke, MP, Bacharach, JM, Jordan, WD, Eskandari, MK & Hagler, DJ 2018, 'Multicenter experience with endovascular treatment of aortic coarctation in adults', Journal of Vascular Surgery. https://doi.org/10.1016/j.jvs.2018.06.209
Erben, Young ; Oderich, Gustavo ; Verhagen, Hence J.M. ; Witsenburg, Maarten ; van den Hoven, Allard T. ; Debus, Eike S. ; Kölbel, Tilo ; Arko, Frank R. ; Torsello, Giovanni B. ; Torsello, Giovanni F. ; Lawrence, Peter F. ; Harlander-Locke, Michael P. ; Bacharach, J. Michael ; Jordan, William D. ; Eskandari, Mark K. ; Hagler, Donald J. / Multicenter experience with endovascular treatment of aortic coarctation in adults. In: Journal of Vascular Surgery. 2018.
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abstract = "Objective: The objective of this study was to evaluate outcomes of endovascular treatment of aortic coarctation in adults. Methods: Clinical data and imaging studies of 93 consecutive patients treated at nine institutions from 1999 to 2015 were reviewed. We included newly diagnosed aortic coarctation (NCO), recurrent coarctation, and aneurysmal/pseudoaneurysmal degeneration (ANE) after prior open surgical repair (OSR) of coarctation. Primary end points were morbidity and mortality. Secondary end points were stent patency and freedom from reintervention. Results: There were 54 (58{\%}) male and 39 (42{\%}) female patients with a mean age of 44 ± 17 years. Thirty-two patients had NCO (mean age, 48 ± 16 years) and 61 had endovascular reinterventions after prior OSR during childhood (mean, 30 ± 17 years after initial repair), including 50 patients (54{\%}) with recurrent coarctation and 11 (12{\%}) with ANE. Clinical presentation included asymptomatic in 31 patients (33{\%}), difficult to control hypertension in 42 (45{\%}), and lower extremity claudication in 20 (22{\%}). Endovascular treatment was performed using balloon-expandable covered stents in 47 (51{\%}) patients, stent grafts in 36 (39{\%}) patients, balloon-expandable uncovered stents in 9 (10{\%}) patients, and primary angioplasty in 1 (1{\%}) patient. Mean lesion length and diameter were 64.5 ± 50.6 mm and 19.5 ± 6.7 mm, respectively. Mean systolic pressure gradient decreased from 24.0 ± 17.5 mm Hg to 4.4 ± 7.4 mm Hg after treatment (P <.001). Complications occurred in nine (10{\%}) patients, including aortic dissections in three (3{\%}) patients and intraoperative ruptures in two patients; type IA endoleak, renal embolus, spinal headache, and access site hemorrhage occurred in one patient each. The aortic dissections and ruptures were treated successfully by deploying an additional covered stent proximal to the site of dissection or rupture. Two patients died within 30 days of the index procedure. After a mean follow-up of 3.2 ± 3.1 years, nearly all patients (98{\%}) were clinically improved and all stents were patent. Reintervention was needed in 10 (11{\%}) patients. Freedom from reintervention at 5 years was 85{\%}. Two additional patients died during follow-up of coarctation-related causes, including rupture of an infected graft and visceral ischemia. Patient survival at 5 years was 89{\%}. Conclusions: Endovascular repair is effective with an acceptable safety profile in the treatment of NCO and postsurgical complications of coarctation after initial OSR. Aortic rupture is an infrequent (2{\%}) but devastating complication with high mortality. Balloon-expandable covered stents are preferred for NCO, whereas stent grafts are used for ANE. The rate of reinterventions is acceptable, with high procedural and long-term clinical success.",
keywords = "Aortic coarctation repair, open and endovascular, Congenital coarctation, Postcoarctation repair in the adult, TEVAR",
author = "Young Erben and Gustavo Oderich and Verhagen, {Hence J.M.} and Maarten Witsenburg and {van den Hoven}, {Allard T.} and Debus, {Eike S.} and Tilo K{\"o}lbel and Arko, {Frank R.} and Torsello, {Giovanni B.} and Torsello, {Giovanni F.} and Lawrence, {Peter F.} and Harlander-Locke, {Michael P.} and Bacharach, {J. Michael} and Jordan, {William D.} and Eskandari, {Mark K.} and Hagler, {Donald J.}",
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TY - JOUR

T1 - Multicenter experience with endovascular treatment of aortic coarctation in adults

AU - Erben, Young

AU - Oderich, Gustavo

AU - Verhagen, Hence J.M.

AU - Witsenburg, Maarten

AU - van den Hoven, Allard T.

AU - Debus, Eike S.

AU - Kölbel, Tilo

AU - Arko, Frank R.

AU - Torsello, Giovanni B.

AU - Torsello, Giovanni F.

AU - Lawrence, Peter F.

AU - Harlander-Locke, Michael P.

AU - Bacharach, J. Michael

AU - Jordan, William D.

AU - Eskandari, Mark K.

AU - Hagler, Donald J.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: The objective of this study was to evaluate outcomes of endovascular treatment of aortic coarctation in adults. Methods: Clinical data and imaging studies of 93 consecutive patients treated at nine institutions from 1999 to 2015 were reviewed. We included newly diagnosed aortic coarctation (NCO), recurrent coarctation, and aneurysmal/pseudoaneurysmal degeneration (ANE) after prior open surgical repair (OSR) of coarctation. Primary end points were morbidity and mortality. Secondary end points were stent patency and freedom from reintervention. Results: There were 54 (58%) male and 39 (42%) female patients with a mean age of 44 ± 17 years. Thirty-two patients had NCO (mean age, 48 ± 16 years) and 61 had endovascular reinterventions after prior OSR during childhood (mean, 30 ± 17 years after initial repair), including 50 patients (54%) with recurrent coarctation and 11 (12%) with ANE. Clinical presentation included asymptomatic in 31 patients (33%), difficult to control hypertension in 42 (45%), and lower extremity claudication in 20 (22%). Endovascular treatment was performed using balloon-expandable covered stents in 47 (51%) patients, stent grafts in 36 (39%) patients, balloon-expandable uncovered stents in 9 (10%) patients, and primary angioplasty in 1 (1%) patient. Mean lesion length and diameter were 64.5 ± 50.6 mm and 19.5 ± 6.7 mm, respectively. Mean systolic pressure gradient decreased from 24.0 ± 17.5 mm Hg to 4.4 ± 7.4 mm Hg after treatment (P <.001). Complications occurred in nine (10%) patients, including aortic dissections in three (3%) patients and intraoperative ruptures in two patients; type IA endoleak, renal embolus, spinal headache, and access site hemorrhage occurred in one patient each. The aortic dissections and ruptures were treated successfully by deploying an additional covered stent proximal to the site of dissection or rupture. Two patients died within 30 days of the index procedure. After a mean follow-up of 3.2 ± 3.1 years, nearly all patients (98%) were clinically improved and all stents were patent. Reintervention was needed in 10 (11%) patients. Freedom from reintervention at 5 years was 85%. Two additional patients died during follow-up of coarctation-related causes, including rupture of an infected graft and visceral ischemia. Patient survival at 5 years was 89%. Conclusions: Endovascular repair is effective with an acceptable safety profile in the treatment of NCO and postsurgical complications of coarctation after initial OSR. Aortic rupture is an infrequent (2%) but devastating complication with high mortality. Balloon-expandable covered stents are preferred for NCO, whereas stent grafts are used for ANE. The rate of reinterventions is acceptable, with high procedural and long-term clinical success.

AB - Objective: The objective of this study was to evaluate outcomes of endovascular treatment of aortic coarctation in adults. Methods: Clinical data and imaging studies of 93 consecutive patients treated at nine institutions from 1999 to 2015 were reviewed. We included newly diagnosed aortic coarctation (NCO), recurrent coarctation, and aneurysmal/pseudoaneurysmal degeneration (ANE) after prior open surgical repair (OSR) of coarctation. Primary end points were morbidity and mortality. Secondary end points were stent patency and freedom from reintervention. Results: There were 54 (58%) male and 39 (42%) female patients with a mean age of 44 ± 17 years. Thirty-two patients had NCO (mean age, 48 ± 16 years) and 61 had endovascular reinterventions after prior OSR during childhood (mean, 30 ± 17 years after initial repair), including 50 patients (54%) with recurrent coarctation and 11 (12%) with ANE. Clinical presentation included asymptomatic in 31 patients (33%), difficult to control hypertension in 42 (45%), and lower extremity claudication in 20 (22%). Endovascular treatment was performed using balloon-expandable covered stents in 47 (51%) patients, stent grafts in 36 (39%) patients, balloon-expandable uncovered stents in 9 (10%) patients, and primary angioplasty in 1 (1%) patient. Mean lesion length and diameter were 64.5 ± 50.6 mm and 19.5 ± 6.7 mm, respectively. Mean systolic pressure gradient decreased from 24.0 ± 17.5 mm Hg to 4.4 ± 7.4 mm Hg after treatment (P <.001). Complications occurred in nine (10%) patients, including aortic dissections in three (3%) patients and intraoperative ruptures in two patients; type IA endoleak, renal embolus, spinal headache, and access site hemorrhage occurred in one patient each. The aortic dissections and ruptures were treated successfully by deploying an additional covered stent proximal to the site of dissection or rupture. Two patients died within 30 days of the index procedure. After a mean follow-up of 3.2 ± 3.1 years, nearly all patients (98%) were clinically improved and all stents were patent. Reintervention was needed in 10 (11%) patients. Freedom from reintervention at 5 years was 85%. Two additional patients died during follow-up of coarctation-related causes, including rupture of an infected graft and visceral ischemia. Patient survival at 5 years was 89%. Conclusions: Endovascular repair is effective with an acceptable safety profile in the treatment of NCO and postsurgical complications of coarctation after initial OSR. Aortic rupture is an infrequent (2%) but devastating complication with high mortality. Balloon-expandable covered stents are preferred for NCO, whereas stent grafts are used for ANE. The rate of reinterventions is acceptable, with high procedural and long-term clinical success.

KW - Aortic coarctation repair, open and endovascular

KW - Congenital coarctation

KW - Postcoarctation repair in the adult

KW - TEVAR

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