Modern Open Surgery for Coral Reef Aorta with Visceral Artery Involvement

Area of Science:

• Vascular Surgery
• Cardiovascular Disease
• Atherosclerosis Research

Background:

• Coral reef atherosclerosis of the visceral aorta (CRA) is a rare condition linked to renovascular hypertension (RVH), chronic mesenteric ischemia (CMI), and lower limb malperfusion.
• Understanding the outcomes of surgical interventions for CRA is crucial for patient management.

Purpose of the Study:

• To describe the outcomes of open surgical repair for Coral reef atherosclerosis of the visceral aorta (CRA).
• To evaluate the safety and efficacy of surgical treatment for CRA, including associated conditions.

Main Methods:

• Retrospective analysis of patients undergoing open surgical repair for CRA between 2009 and 2023.
• Pre-operative computed tomography angiography (CTA) and Kaplan-Meier survival/patency analysis were utilized.
• Follow-up assessed clinical improvement in walking, blood pressure, and ischemia, alongside post-operative survival and patency rates.

Main Results:

• Thirty-eight patients (mean age 65, 57.9% female) underwent surgery for RVH (40.6%), CMI (25%), or lower limb malperfusion (71.9%).
• One operative death (2.6%) occurred; significant morbidity included myocardial infarction (7.9%) and acute kidney failure (28.9%).
• Post-operatively, all CMI and claudication patients improved, 56.7% saw hypertension improvement, with 1- and 5-year survival rates of 91.9% and 61.6% respectively.

Conclusions:

• Left-sided lumbotomy with visceral aortic endarterectomy, guided by CTA, is a safe and effective treatment for CRA.
• The procedure demonstrates low operative mortality and acceptable morbidity.
• Long-term monitoring via duplex scan or CTA is recommended due to restenosis risk.