[Coarctation of the thoraco-abdominal aorta. Problems of surgical methodology]

Coarctations of the thoraco-abdominal aorta are rare malformations. Whilst determining the need for surgery, in general because of hypertension, raises few problems, the choice of surgery tactics gives rise to discussion. The choice must above all take into account the risks of visceral ischaemia, in particular affecting the spinal cord, the causes of which are at one and the same time technical (total aortic clamping, sacrifice of the intercostal arteries) and haemodynamic (blood pressure variations). Under such conditions, it would seem necessary to reject resection-suture. Discussion is thus limited to aortoplasty with a widening patch, which is suitable in particular for short stenoses of easy access and to by-pass from ascending aorta to abdominal aorta, electively more indicated in cases of extensive coarctation with severe periaortitis, though the long-term fate of such by-passes remains uncertain.