Author + information
- Received July 1, 2013
- Accepted July 3, 2013
- Published online March 1, 2014.
- Cecilia Craviari∗,
- Nathaniel W. Taggart, MD∗,
- Frank Cetta, MD∗,†,
- Donald J. Hagler, MD∗,†,
- Thomas C. Bower, MD‡,
- Daniel A. Mauriello, MD∗ and
- Jonathan N. Johnson, MD∗∗ ()
- ∗Department of Pediatrics/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
- †Department of Medicine/Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
- ‡Department of Surgery/Division of Vascular Surgery, Mayo Clinic, Rochester, Minnesota
- ↵∗Reprint requests and correspondence:
Dr. Jonathan N. Johnson, Pediatric Cardiology, Mayo Clinic, Gonda 6-138SW, 200 First Street SW, Rochester, Minnesota 55905.
A 44-year-old woman presented to our institution for evaluation of an expanding aortic saccular pseudoaneurysm. She had a history of an end-end repair of coarctation of the aorta at 4 years of age. At 29 years of age, she received a diagnosis of a pseudoaneurysm measuring 10 mm at the site of the previous repair. Since that time, the pseudoaneurysm had doubled in size. She also had a history of hypertension and had been treated with atenolol.
At time of our evaluation, computed tomography angiography was performed, demonstrating mild narrowing of the aorta just distal to the origin of the left subclavian artery with a minimal diameter of 16 mm (Fig. 1). The pseudoaneurysm measured 21 × 17 × 20 mm.
Due to the location of the pseudoaneurysm just distal to the origin of the left subclavian artery, the vascular surgery team translocated the left subclavian artery to the left carotid artery. Two months later, with approval from the U.S. Food and Drug Administration for compassionate use, she underwent placement of a 20-mm × 3.4-cm covered stent (Cheatham-Platinum [CP] stent, NuMED, Hopkinton, New York) to dilate the coarctation and simultaneously cover the saccular pseudoaneurysm. The stent was pre-mounted on a 20-mm balloon-in-balloon (BIB) catheter. Post-procedure DynaCT rotational angiography (Siemens, Erlangen, Germany) demonstrated a 7-mm residual neck not covered by the stent (Fig. 2). The patient returned for additional placement of 2 CP stents (3.4 and 2.8 cm) placed over a 20-mm BIB catheter covering the orifice of the pseudoaneurysm. Post-procedure, there was no evidence of residual aneurysm filling or dissection on DynaCT imaging, and the patient tolerated the procedure well (Fig. 3). Follow-up 12 months later revealed an excellent result with no residual pseudoaneurysm and no residual gradient.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 1, 2013.
- Accepted July 3, 2013.
- American College of Cardiology Foundation