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Treatment Of Aortic Coarctation By Self-Expanding Thoracic Endograft With Left Subclavian In Situ Laser Fenestration.

INTRODUCTION: Thoracic endovascular aortic repair (TEVAR) with self-expanding endo-graft is increasingly used as a viable treatment option for adult aortic coarctation (AC).

METHODS: We hereby reported a 55 years old gentleman with late presentation of AC, treated by a novel strategy with thoracic endograft and in situ laser fenestration for left subclavian artery (LSA) revascularization.

RESULTS: AC was incidentally discovered during coronary angiogram as an investigation for his angina pectoris. TEVAR with self-expanding endograft was chosen because pre-operative computer tomography scan showed ectatic thoracic aorta and the stenosis just distal to the LSA. The patient was planned for a timely second stage aortic valve replacement and coronary artery bypass grafting using left internal mammary artery shortly after TEVAR, which required a patent LSA. The procedure was arranged semi-urgently. A 34mm thoracic tube endograft was placed across the coarctation with proximal landing distal to left common carotid artery. In situ fenestration was created by laser catheter through retrograde left brachial access. The fenestration was then enlarged by balloon dilatation and bridged to left subclavian origin with a 16mm balloon expandable covered stent.

CONCLUSION: TEVAR with in situ fenestration for LSA is a reliable choice for adult aortic coarctation. The technique added to the armamentarium of treatment options.

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