Coarctation of Abdominal Aorta. Aortic Angioplasty with Left Iliac Artery Patch and Reimplantation of Left Renal Artery. Right Kidney Auto Transplantation. Thoraco Abdominal Bypass at 12 Years. 22 Years Follow Up
Seance of wednesday 04 december 2019 (Communications libres)
DOI number : 10.26299/dd4r-pn12/emem.2018.3.004
Abstract
Abdominal aorta coarctations are rare. They are most often due to embriologic malformation. Clinical presentation is usually arterial hypertension difficult to control by medical therapy. Endoluminal procedures by angioplasty and stent give only short-term results Surgical treatment must avoid prosthetic by pas before adult age
We present a clinical case in a child aged 4.5 years with a long coarctation from the coeliac branches down to infra renal aorta. After medico surgical meeting, it was decided to realize an autogenous reconstruction. Surgical treatment was done on 26/03/1998, by a long thoraco lombar approach. The aorta has been controlled from D8 to the primary left iliac artery. The primitive iliac artery was controlled and divided to realize a patch After aortic clamping, a long aortotomy was done from infra renal aorta to supra renal aorta and closed by the iliac patch (clamping time: 32 mn). Left renal artery was re implanted on the left side of the patch (Clamping time: 12mn). At the end of the procedure, the left primary iliac artery was reimplanted on the right primary iliac artery Post-operative cause was uneventful.
In January 1999, the patient was reevaluated for a persistent hypertension. CT scan shown a good result of aortic angioplasty and of the left renal artery reimplantation, and a tight stenosi of the right renal artery Right renal auto transplantation was realized on 26/ 02 /1999, without complication.
On April 2001, the patient weight 32 kg for 1,25 m. Clinical situation had deteriorated with hypertension non controlled. Angio IRM showed restenosis of aortic angioplasty. Waiting for a complete growing, an aortic angioplasty was done. On April 2009, the patient was 16 years Angio CT scan showed intra stent restenosis. We decided an aortic by-pass from ascending aorta to abdominal aorta with reimplantation de superior mesenteric artery CT Scan control showed patency of both renal arteries and superior mesenteric artery Since that date, the patient was followed in Lille university hospital. In December 2018, the patient suffered septicemia secondary to right pyelo nephritis CT scan showed atrophy of right renal. After four weeks of antibiotherapy, the clinical situation was stabilized and a right nephrectomy was realized in May 2019. Since that date, the patient had a controlled hypertension and a normal renal. This observation shows the interest of surgical revascularization with autogenous tissue, allowing a complete revascularization at adult age. This observation has a 22 year follow up. We shall do an extensive review of literature.
We present a clinical case in a child aged 4.5 years with a long coarctation from the coeliac branches down to infra renal aorta. After medico surgical meeting, it was decided to realize an autogenous reconstruction. Surgical treatment was done on 26/03/1998, by a long thoraco lombar approach. The aorta has been controlled from D8 to the primary left iliac artery. The primitive iliac artery was controlled and divided to realize a patch After aortic clamping, a long aortotomy was done from infra renal aorta to supra renal aorta and closed by the iliac patch (clamping time: 32 mn). Left renal artery was re implanted on the left side of the patch (Clamping time: 12mn). At the end of the procedure, the left primary iliac artery was reimplanted on the right primary iliac artery Post-operative cause was uneventful.
In January 1999, the patient was reevaluated for a persistent hypertension. CT scan shown a good result of aortic angioplasty and of the left renal artery reimplantation, and a tight stenosi of the right renal artery Right renal auto transplantation was realized on 26/ 02 /1999, without complication.
On April 2001, the patient weight 32 kg for 1,25 m. Clinical situation had deteriorated with hypertension non controlled. Angio IRM showed restenosis of aortic angioplasty. Waiting for a complete growing, an aortic angioplasty was done. On April 2009, the patient was 16 years Angio CT scan showed intra stent restenosis. We decided an aortic by-pass from ascending aorta to abdominal aorta with reimplantation de superior mesenteric artery CT Scan control showed patency of both renal arteries and superior mesenteric artery Since that date, the patient was followed in Lille university hospital. In December 2018, the patient suffered septicemia secondary to right pyelo nephritis CT scan showed atrophy of right renal. After four weeks of antibiotherapy, the clinical situation was stabilized and a right nephrectomy was realized in May 2019. Since that date, the patient had a controlled hypertension and a normal renal. This observation shows the interest of surgical revascularization with autogenous tissue, allowing a complete revascularization at adult age. This observation has a 22 year follow up. We shall do an extensive review of literature.