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Chimney Technique to Preserve Visceral Flow in a Coral Reef Aorta
Hugo T C Veger1, Randolph G Statius van Eps1, Jan J Wever1
1Department of Vascular Surgery, Haga Hospital, The Hague, The Netherlands.
Insights
Coral reef aorta (CRA), a rare aortic calcification, poses risks. A chimney graft procedure effectively treated a patient with suprarenal CRA and associated visceral artery issues, offering a potential solution for high-risk individuals.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
Background:
- Coral reef aorta (CRA) is a rare condition characterized by extreme calcification in the juxtarenal and suprarenal aorta.
- Open revascularization for CRA carries a significant in-hospital mortality rate of 13%.
Observation:
- A patient presented with suprarenal CRA complicated by colon ischemia.
- The patient had a history of percutaneous transluminal angioplasty and stenting of the celiac trunk (CT) and superior mesenteric artery (SMA).
- Computed tomography angiography revealed CRA with CT stent occlusion and near SMA stent occlusion.
Findings:
- The chimney graft procedure was successfully employed to treat the suprarenal CRA in this patient.
- This approach addressed the complex vascular anatomy and ischemia.
Implications:
- The chimney graft procedure may be a viable treatment option for suprarenal CRA, particularly in high-risk patients.
- Further long-term follow-up studies are needed to fully establish the durability and safety of this intervention for CRA.
Abstract:
The coral reef aorta (CRA) is a rare phenomenon of extreme calcification in the juxtarenal and suprarenal aorta. Open revascularization has an overall in-hospital mortality rate of 13%. We present a patient with a suprarenal CRA with colon ischemia. She has an extensive past medical history of percutaneous transluminal angioplasty and stenting of the celiac trunk (CT) and superior mesenteric artery (SMA). The computed tomography angiography showed a CRA of the suprarenal aorta with occlusion of the CT stent and near occlusion of the SMA stent. Our case illustrates that the CRA in the suprarenal part of the aorta can be treated well by chimney graft procedure, although owing to lack of long-term follow-up, it might be reserved for high-risk candidates for (thoraco)abdominal aortic surgery.
