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Emergency Endovascular Treatment of Coral Reef Aorta with an Unconventional Technique
Emanuele Gatta1, Paolo Berretta2, Gabriele Pagliariccio1
1Vascular Surgery Unit, Lancisi Cardiovascular Center, Ancona Italy.
Insights
Coral reef aorta (CRA), a rare condition causing aortic calcification, can lead to severe ischemia. Endovascular repair using a stent graft offers a viable emergency treatment option for CRA, successfully managing acute limb ischemia in a recent case.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Radiology
Background:
- Coral reef aorta (CRA) is a rare condition characterized by extensive aortic calcification obstructing blood flow.
- CRA can cause severe downstream ischemic and embolic events affecting vital organs and limbs.
- Open surgical repair is traditionally the primary treatment for CRA.
Observation:
- A 70-year-old woman presented with acute bilateral limb ischemia and abdominal pain.
- Angio-CT revealed severe calcified coarctation with thrombosis, occluded mesenteric arteries, and kidney ischemia.
- The patient underwent urgent endovascular repair due to the acute presentation.
Findings:
- Initial balloon angioplasty followed by stent graft deployment successfully treated the aortic coarctation.
- The procedure reduced the aortic gradient to zero without complications.
- Postoperative imaging confirmed proper stent graft deployment and no residual stenosis.
Implications:
- Endovascular repair with stent grafts is a potentially accurate emergency treatment for CRA.
- This approach allows for protected balloon angioplasty and safe stent graft placement.
- It offers a less invasive alternative for managing acute CRA complications.
Abstract:
Coral reef aorta (CRA) is a rare condition featured by rock-hard calcifications that grow into the lumen of the thoracoabdominal aorta. Patients suffering from CRA may present severe downstream ischemic and embolic events involving the viscera and the lower limbs. In these patients, open surgical repair is the first choice of treatment. We present a case of a 70-year-old woman with acute presentation of bilateral limb ischemia and abdominal pain. An angio-computed tomography (CT) scan showed the subocclusion of the distal thoracic aorta due to a severe calcified coarctation with intraluminal thrombosis, a chronic occlusion of the superior mesenteric and celiac trunk arteries, a hypertrophic inferior mesenteric artery associated with signs of partial left kidney ischemia. The patient underwent urgent endovascular repair. A soft dilatation of the coarctation using a 7-mm noncompliant balloon was initially performed; a 21-mm conformable thoracic stent graft was subsequently deployed and increasingly dilated using progressively larger angioplasty balloons. The procedure was uneventful and the aortic gradient was reduced to zero. A postoperative CT scan revealed the proper deployment of the graft with no residual stenosis. Endovascular approach with the covered thoracic stent graft could be an accurate technique to treat CRA in the emergency setting. It allows for a primary protected balloon angioplasty and, in case of aortic-graft recoiling, a subsequent placement of covered or uncovered balloon-expandable stent graft can be safely and easily performed.
