Hybrid Surgical Approach to a Giant Post-Coarctation Aortic Aneurysm

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Medicine

Background:

• Aortic coarctation (CoA) is a congenital heart defect rarely diagnosed in adulthood.
• Giant descending thoracic aneurysms are infrequent complications of CoA.
• Acute aortic dissection poses a significant surgical challenge, particularly in patients with pre-existing aortic malformations.

Observation:

• A 57-year-old male presented with acute chest pain, found to have a giant (14 cm) descending thoracic aneurysm secondary to CoA.
• The patient also had a concomitant left subclavian artery (LSA) aneurysm and an acute type B aortic dissection.
• A computed tomography angiography (CTA) confirmed the complex aortic pathology.

Findings:

• A single-stage hybrid procedure was successfully performed, involving LCCA-LSA bypass followed by thoracic endograft and aortic dissection stent placement.
• The patient was discharged on postoperative day 8 with no complications.
• A 1-month follow-up CTA showed patent supra-aortic and visceral vessels, successful exclusion of the false lumen, and dilation at the CoA site.

Implications:

• This case highlights the feasibility and safety of a hybrid approach for managing complex aortic pathologies like giant CoA with dissection.
• Such combined malformations present unique surgical challenges, requiring tailored endovascular and open surgical techniques.
• The hybrid strategy provides a viable option for complex aortic reconstructions in adult patients, improving outcomes.