Coarctation of the abdominal aorta in elderly patients. Case report and review of the literature

HISTOLOGIC AND MORPHOLOGIC CHARACTER OF PEDIATRIC ABDOMINAL AORTIC DEVELOPMENTAL COARCTATION AND HYPOPLASIA

OBJECTIVES

Abdominal aortic coarctation and hypoplasia are uncommon diseases, recognized most often in pediatric-aged individuals. Comprehensive studies regarding the pathologic spectrum of these aortopathies are nonexistent. This investigation was undertaken to better define the histologic and morphologic character of abdominal aortic narrowings affecting children and assess its potential relevance to contemporary clinical practice.

METHODS

Aortic specimens obtained during open operations in children being treated for symptomatic, noninflammatory abdominal aortic narrowings at the University of Michigan were subjected to histologic study following hematoxylin-eosin, Movat, Verhoeff Van Gieson, and Masson's trichrome preparations. Microscopic findings were correlated with the anatomic aortic images. In addition, a detailed review was completed of all prior reports in the English literature that included images depicting the histologic character of noninflammatory abdominal aortic narrowings in children.

RESULTS

Among a series of 67 pediatric-aged individuals undergoing open surgical interventions for abdominal aortic narrowings, eight children ranging in age from 9 months to 18 years, had adequate aortic tissue available for study. The loci of the specimens paralleled the anatomic sites of segmental coarctations observed in the entire series, with involvement of the suprarenal abdominal aorta (3), intrarenal aorta (2), and infrarenal aorta (1). Diffusely hypoplastic abdominal aortas (2) included one case of a de facto aortic duplication, represented by a channel that paralleled the narrow native aorta and gave origin to celiac artery branches, as well as the superior mesenteric and renal arteries. Concentric or eccentric intimal fibroplasia was observed in every aorta, often with internal elastic fragmentation and duplication (4). Media abnormalities included elastic tissue disorganization (3), and focal medial fibrosis (1). Organizing luminal thrombus occurred in two infants. Coexistent ostial stenoses of the celiac, superior mesenteric, or renal arteries were observed in all but the only child who having an infrarenal aortic coarctation. Neurofibromatosis-1 affected one child whose histologic findings were indistinguishable from those of the other children. Review of prior published histologic images of abdominal aortic coarctation and hypoplasia affecting children from other centers revealed a total of 14 separate reports, each limited to single case photomicrographs of which 11 exhibited intimal fibroplasia.

CONCLUSIONS

Intimal fibroplasia is a common accompaniment of developmental abdominal aortic coarctation and hypoplasia. It is posited that intimal fibroplasia, that is likely progressive in instances of abnormal shear stresses in these diminutive vessels, may contribute to less salutary outcomes following endovascular and certain open reconstructions of pediatric abdominal aortic narrowings.

Coarctations of descending and abdominal aorta: long-term results of surgical therapy

PURPOSE

Nonarteriosclerotic and nonarteritic descending and abdominal aortic coarctation (DAAC) is a rare disease with a great variety of morphologic findings. The additional affliction of renal and other splanchnic arteries often affords complex corrective procedures. We report on our single-center long-term experiences with operative treatment of this malformation.

METHODS

Over a period of 21 years, 15 patients (10 female and 5 male patients; age range, 8 to 57 years) were operated on for DAAC. Six patients had additional stenoses of eight renal arteries, and three had splanchnic arterial obstructions. At 4 to 25 years after the operation, all surviving patients underwent a clinical and a spiral computed tomography examination.

RESULTS

There was one intraoperative death due to exsanguination after the rupture of a poststenotic aneurysm of the infrarenal aorta. Fourteen patients were discharged free of symptoms. During follow-up, four repeated operations were necessary for renal arterial bypass stenoses or aneurysms. One late death occurred as the result of an unrelated disease.

CONCLUSIONS

Complete operative correction of DAAC usually can be accomplished as a single-stage procedure with low morbidity and mortality rates. The reconstruction of all renal arteries is essential to cure hypertension. Consequent follow-up is recommended for detection of late postoperative complications.

Abdominal aortic coarctation: CT, MRI, and angiographic correlation

Abdominal aortic coarctation is an uncommon entity in the elderly. We present a case of abdominal aortic coarctation with computed tomography (CT), magnetic resonance imaging (MRI) and conventional angiographic correlation. CT and MR imaging detected an abnormal abdominal aorta distal to the origin of the celiac axis with the diagnosis of abdominal aortic coarctation confirmed by conventional angiography. Clinical presentation and diagnostic imaging findings depend on the level of the coarctation and its relationship to the renal vessels.

Takayasu's aortitis with renovascular hypertension

We report a case of Takayasu's disease with severe renovascular hypertension in a girl from Eritrea. In the "burn-out" phase after the erythrocyte sedimentation rate had normalized, reconstructive vascular surgery was performed as further progression of the disease seemed unlikely. However, probably due to her growth, the graft rotated and a second operation was successfully performed.