Coral reef aorta: a long-term study of 21 patients

Coral reef aorta is a rare calcifying disease of the juxtarenal and suprarenal aorta. We report here our surgical experience in treating 21 patients, with a mean follow-up of 4 years and 7 months. Both genders were equally affected. Ten male (48%) and 11 female (52%) patients with a mean age of 54.6 years (range 42-76 years) underwent surgery. The main symptoms were limb claudication (n = 11, 52%), renovascular stenosis (n = 9, 43%) with concurrent renovascular hypertension (n = 5, 24%), and angina abdominalis (n = 7, 33%). Most patients had multiorgan vascular disease such as iliofemoral arterial occlusive disease (n = 14, 66%), coronary artery obstruction (n = 8, 38%), or obstruction of the carotid artery (n = 6, 28%). Risk factors did not differ between coral reef patients and those with other occlusive vascular diseases. All patients were treated through vascular operations, including open thromboendarterectomy of the suprarenal (n = 9, 43%), infrarenal (n = 4, 19%), or supra- and infrarenal aorta (n = 8, 38%), and thromboendarterectomy of the following vessels: celiac artery (n = 7, 33%), superior mesenteric artery (n = 12, 57%), inferior mesenteric artery (n = 3, 14%), unilateral renal artery (n = 3, 14%), or bilateral renal artery (n = 9, 43%). Bypass reconstructions were performed in 39% (n = 8). A thoracoabdominal approach was used in 14 patients (67%) and a median laparotomy in 7 (33%). Our results show that coral reef aorta is not confined to either gender. It appears most frequently in the context of general atherosclerotic disease and patients benefit from timely diagnosis and operation before onset of severe, life-threatening visceral and renal complications.