Successful endovascular management of coral reef aortic occlusion

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Endovascular Interventions

Background:

• Transaortic thromboendarterectomy and bypass are traditional treatments for coral reef aortic occlusions.
• These conventional methods carry high risks of mortality, morbidity, and reintervention, especially in patients with comorbidities like heart failure, hypertension, and renal dysfunction.
• Endovascular treatment has been approached cautiously due to concerns about aortic rupture and visceral ischemia.

Purpose of the Study:

• To evaluate the safety and efficacy of endovascular management for coral reef aorta.
• To present the experience of managing 10 patients with this challenging condition using minimally invasive techniques.

Main Methods:

• Retrospective analysis of 10 patients with coral reef aorta undergoing endovascular procedures.
• Procedures included aortic stenting (bare metal and covered), aortoiliac stenting, and renal artery stenting.
• Intravascular lithotripsy was utilized in two cases with suprarenal aortic occlusion.
• All procedures were performed under local anesthesia.

Main Results:

• Technical success was achieved in all 10 patients.
• Successful blood pressure control and increased Ankle Brachial Index (ABI) were observed.
• Presenting symptoms included uncontrolled hypertension, chronic renal disease, disabling claudication, and critical limb ischemia with tissue loss.
• Comorbidities involved infrarenal/suprarenal aortic occlusion, visceral vessel involvement, and renal artery stenosis.

Conclusions:

• Endovascular management is a viable and effective treatment for coral reef aorta.
• This minimally invasive approach can be performed safely under local anesthesia, offering an alternative to high-risk open surgery.
• Further research is warranted to explore long-term outcomes and expand indications.