Transcatheter treatment of "complex" aortic coarctation.

A young woman, submitted to aortic coarctation repair in early infancy, was referred with clinical and echocardiographic signs of severe recoarctation. Spiral CT scan confirmed the aortic isthmus obstruction but imaged also a huge aneurysm distal to the coarctation site, from which arose a large aberrant right subclavian artery. In cardiac catheterization, this vessel showed an upper-to-lower flow direction and its closure was deemed mandatory to abolish a major feeding source to the aneurysmal sack. Thus, this anomalous vessel was occluded with an Amplatzer Duct Occluder device and multiple covered Cheatham-Platinum stents were telescopically implanted into the thoracic aorta to dilate the coarctation and exclude the aneurysm. In conclusion, percutaneous transcatheter treatment is feasible, safe, and cost-effective even in aortic arch obstructions with complex anatomic arrangement.