Hybrid Repair of a Descending Aortic Pseudoaneurysm With Iatrogenic Coarctation

The authors present a combined open and endovascular approach to a descending aortic pseudoaneurysm with iatrogenic coarctation.

A 64-year-old man was found to have a pseudoaneurysm associated with coarctation at the anastomosis of a previous descending thoracic aortic coarctation repair. An endograft alone would not achieve an adequate seal in zone 2 and risked a worsening of the high pressure gradient across the coarctation. A left carotid subclavian transposition was performed initially. An ascending aorta-to-descending aorta bypass followed by ascending aorta-to-left common carotid artery bypass was then performed. Next, a 34 x 30 x 150 Relay endograft (Bolton Medical, Sunrise, FL, USA) was placed from zone 2 to the mid-descending thoracic aorta. Postoperative computed tomography scan demonstrated an intact repair without endoleak. The patient had an uneventful hospital course and was discharged on postoperative day nine.

A hybrid approach allows for the successful repair of a descending aortic pseudoaneurysm with coarctation.