Nonarteritic and nonarteriosclerotic atypical thoracoabdominal aortic coarctation (ATAC) is a rare, often inherited malformation. If the abdominal aorta is involved, additional stenoses of visceral arteries may occur, making surgical correction difficult. A literature review was done to accumulate information on the etiology, epidemiology, and surgical therapy of ATAC.
Detailed reports on the surgical management of 228 ATAC patients were found in world literature between 1951 and 1996. Most patients were operated on during their first two decades of life. In only about 10% of them could associated diseases (neurofi bromatosis in 7%) be identified, leaving a 90% rate of probably inborn malformations. Main preoperative symptom was renovascular hypertension due to suprarenal or inter renal coarctation, often combined with renal arterial stenoses.
Although most of the patients had complex procedures for complete revasculariza tion, perioperative mortality was only 5%. More than 90% of the patients were completely free of symptoms after their operation. Aortic patch angioplasty seems to be burdened with a higher rate of long-term complications than aorto-aortic bypass. Consequent follow-up of all of the young patients is recommended.
Get full access to this article
View all access options for this article.
References
1.
Panayiotopoulos YP, Tyrrell MR, Koffman G., et al: Midaortic syndrome presenting in childhood . Br J Surg83:235-240, 1996.
2.
Wukasch DC, Cooley DA, Sandiford FM, et al: Ascending aorto-abdominal aorta bypass: Indications, technique, and report of 12 patients. Ann Thorac Surg22:442-448, 1977.
3.
Bergdahl L., Ljungqvist A.: Long-term results after repair of coarctation of the aorta by patch grafting . J Thorac Cardiovasc Surg80:177-181, 1980.
4.
Hanson J., Ikkos D., Johansson L., et al: Coarctation of the abdominal aorta. Case report and description of successful surgical treatment. Acta Chir Scand245(Suppl):315-322, 1959.
5.
Senning Å. , Johannson L.: Coarctation of the abdominal aorta. J Thorac Cardiovasc Surg40:517-523, 1960.
6.
Beattie EJ, Cooke FN, Paul JS, et al: Coarctation of the aorta at the level of the diaphragm treated successfully with a preserved human blood vessel graft. J Thorac Surg21:506-512, 1951.
7.
Onat T., Zeren E.: Coarctation of the abdominal aorta. Review of 91 cases. Cardiologia54:140-157, 1969.
8.
Bircks W., Kort J., Kremer K.: Die operative Behandlung tiefer Aortenstenosen. Thoraxchirurgie10:291-304, 1962.
9.
Schuster SR: Coarctation of the abdominal aorta. Ann Surg158:1012-1019, 1963.
10.
Bercot M., Idatte JM, Piwnica A.: Hypertension artérielle sévère par sténose de l'aorte sous-diaphragmatique. Cure chirurgicale. NouvPresse Méd1:2539-2542, 1972.
11.
Bergentz SE , Bergqvist D., Ericsson BF, et al: Coarctation of the abdominal aorta associated with renal hypertension. Vasa12:133-138, 1983.
12.
De Gregorio MA, Alfonso ER, Fernández JA, et al: Percutaneous transluminal angioplasty in aortic and renal stenosis in a child with neurofibromatosis . Eur J Pediatr154:78-81, 1995.
13.
Elias DL, Ricketts RR, Smith RB: Renovascular hypertension complicating neurofibromatosis. Am Surg51:97-109, 1985.
14.
Glenn F., Keefer Ebc, Speer DS, et al: Coarctation of the lower thoracic and abdominal aorta immediately proximal to celiac axis. Surg Gynecol Obstet74:561-569, 1952.
15.
Graham LM, Zelenok GB, Erlandson EE, et al: Abdominal aortic coarctation and segmental hypoplasia. Surgery86:519-529, 1979.
16.
Messerli FH , Nachbur B., Senn A., et al: Arterielle Hypertonie bei Koarktation der Aorta abdominalis. Zeitschr Kardiol63:521-530, 1974.
17.
Riemenschneider TA, Emmanouilides GC, Hirose F., et al: Coarctation of the abdominal aorta in children: Report of three cases and review of the literature. Pediatrics44:716-726, 1969.
18.
Rowen M., Dorsey TJ, Kegel SM, et al: Thoracic coarctation associated with neurofibromatosis. Am J Dis Child129:113-115, 1975.
19.
Vaccaro PS, Myers JC, Smead WL: Surgical correction of abdominal aortic coarctation and hypertension . J Vasc Surg3:643-648, 1986.
20.
Calhoun TR, Thumwood RG, Tennyson KB, et al: Coarctation of the abdominal aorta. Texas Heart Inst J10:269-273, 1983.
21.
Patel J., Facquet J.Essais de cure des sténoses ectopiques de l'aorte. Presse Med61:743-744, 1953.
22.
Maycock WA: Congenital stenosis of the abdominal aorta. Am Heart J13:633-646, 1937.
23.
Morris GC, DeBakey ME, Cooley DE, et al: Subisthmic aortic stenosis and occlusive disease. Arch Surg80: 87-102, 1960.
24.
Nennhaus HP , Javid H., Hunter JA: Surgical treatment of renovascular hypertension in children with a review of infradiaphragmatic arterial hypoplastic anomalies . J Thorac Cardiovasc Surg54:246-258, 1967.
25.
Rees AH, Elbl F., Villafane J., et al: Surgical repair of atypical coarctation of the abdominal aorta in an infant. KentuckyMed J88:62-65, 1990.
26.
Limbacher JP , Hill ME, Janicki PC: Hypoplasia of the abdominal aorta associated with Rubella syndrome. South Med J72:617-619, 1979.
27.
Arnot RS, Louw JH: The anatomy of the posterior wall of the abdominal aorta. First significance with regard to hypoplasia of the distal aorta. South Afr Med J47:899-902, 1973.
28.
Vollmar J., Voss EU, Nadjafi AS, et al: Die atypische Coarctatio aortae. Thoraxchirurgie24:107-118, 1976.
29.
Albanese AR , Lazzarini AA: Coarctation of the abdominal aorta—graft of preserved aorta. Angiology4:429-435, 1953.
30.
Gayet JL, Froment JC, Pinet F.: Les sténoses idiopathiques ou dysgenetiques de l'aorte abdominale. A propos de 9 observations avec aortographie et revue de la littérature. Lyon Méd241:205-212, 1979.
31.
Kremer K., Loose DA, Moschinski D., et al: Coarctatio aortae abdominalis. Vasa4:125-132, 1975.
32.
Sproul G., Pinto J.: Coarctation of the abdominal aorta. Arch Surg105:571-573, 1972.
33.
Ben-Shoshan M., Rossi NP, Korns ME: Coarctation of the abdominal aorta. Arch Pathol95:221-225, 1973.
34.
Nuboer JF: Treatment of certain coarctations with homologous grafts fixed in 4% formalin . Arch Chir Neerl6:123-142, 1954.
35.
Martin EC, Diamond NG, Casarella WJ: Percutaneous transluminal angioplasty in nonatherosclerotic disease . Radiology135:27-33, 1980.
36.
Sievert H., Bussmann WD, Klepzig H., et al: Koarktation der abdominellen Aorta. Erfahrungen mit der transluminalen Angioplastik. Dtsch Med Wochenschr112:1536-1538, 1987.
37.
Björk VO, Intonti F.: Coarctation of abdominal aorta with right renal artery stenosis. Ann Surg160:54-60, 1964.
38.
DeBakey ME, Garrett E., Howell JF, et al: Coarctation of the abdominal aorta with renal arterial stenosis: Surgical considerations. Ann Surg165: 830-843, 1967.
David M., Putelat R., Louis P., et al: Coarctation de l'aorte abdominale associée à une dysplasie des deux artères rénales traitée par pontage puis par autotransplantation rénale bilatérale. Ann Chir Thorac Cardiovasc17:197-202, 1978.
41.
Courbier R. , Jausseran JM, Reggi M.: Hypoplasie de l'aorte abdominale. A propos de quatre cas opérés. Chirurgie100:284-290, 1974.
42.
Hallett JW, Brewster DC, Darling RC, et al: Coarctation of the abdominal aorta. Current options in surgical management. Ann Surg191:430-437, 1980.
43.
Giraud C., Cuq P., Tasrini J., et al: Hypoplasies de l'aorte abdominale. Revue de la littérature à propos de 4 observations. Arch Mal Coeur78:931-937, 1985.
44.
Abad C., Ninot S., Barriuso C., et al: Coartación de aorta abdominal. Tratamiento quirúrgico. Angiologia41:149-155, 1989.
45.
Bacourt F., Goëau-Brissonnière O., Montète P., et al: Coarctation of the suprarenal aorta: A new surgical approach . Br J Surg74:1175-1176, 1987 .
46.
Blondeau P. , Cachera JP: Problèmes posés par le traitement chirurgical des sténoses congénitale de l'aorte abdominale intéressant la zone d'implantation des artères rénales (à propos de deux observations). Mém Acad Chir10/11:291-301, 1969.
47.
Frøysaker T. , Skagseth E., Dundas P., et al: Bypass procedures in the treatment of obstructions of the abdominal aorta. J Cardiovasc Surg14:317-321, 1973.
48.
Heberer G., Schildberg FW, Becker HM, et al: Die atypische suprarenale Aortenstenose als Ursache eines juvenilen Hypertonus. Dtsch Med Wochenschr100:649-659, 1975.
49.
Huang TT, Wolma FJ, Tyson KR: Coarctation of the abdominal aorta. Etiologic considerations in surgical management . Am J Surg120:598-601, 1970.
50.
Janzen J., Bürger K., Scholz H.: Zum Krankheitsbild der atypischen Coarctatio aortae. Helv Chir Acta60:291-298, 1993.
51.
Poulias GE, Skoutas B., Doudoulakis N., et al: The midaortic dysplastic syndrome. Surgical consideration with a 2- to 18-year follow-up and selective histopathology study. Eur J Vasc Surg4:75-82, 1990.
52.
Robicsek F. , Daugherty HK, Cook JW, et al: Coarctation of the abdominal aorta with stricture of the major vessels. Surgery87:545-548, 1980.
53.
Tübergen D. , Walter M., Erasmi H.: Die Koarktation der Aorta abdominalis—ein häufig verkanntes Krankheitsbild. Angio13:239-247, 1991.
54.
Vuong PN, Trinh AC, Lagneau P., et al: Coarctation of the abdominal aorta and stenosis of the left renal artery with hypertension caused by fibrodysplasia. Arcl PatholLab Med113:809-811, 1989.
55.
Conolly JE: Fibromuscular dysplasia of the abdominal aorta. J Cardiovasc Surg19:563-566, 1978.
56.
Letsch R., Kantartzis M., Sommer T., et al: Arterial fibromuscular dysplasia. Report of a case with involvement of the aorta and review of the literature. Thorac Cardiovasc Surg28:206-210, 1980.
57.
Daniels SR, Loggie Jmh, Schwartz DC, et al: Systemic hypertension secondary to peripheral vascular anomalies in patients with Williams syndrome. J Pediatr105:249-251, 1985.
58.
Maisuls H., Alday LE, Thüer O.: Cardiovascular findings in the Williams-Beuren syndrome. Am Heart J114:897-899, 1987.
59.
Beaudet AL, DiFerrante NM, Ferry GD, et al: Variation in the phenotypic expression of β-glucuronidase deficiency. J Pediatr86:388-394, 1975.
60.
Al-Naaman YD , Samarrai AR, Ghani AR, et al: Congenital anomalies of the aorta and renal arteries associated with hypertension in children and young adults . J Cardiovasc Surg14:178-192, 1973.
61.
Annamalai A. , Shreekumar S.: Crural hypertension in abdominal aortic coarctation. Am Heart J78:541-544, 1969.
62.
Bahabozorgui S., Nemir P.: Coarctation of the abdominal aorta . Am J Surg111:224-229, 1966.
63.
Baird RJ, Evans JB, Labrosse CL: Coarctation of the abdominal aorta. Arch Surg89:466-474, 1964.
64.
Bates RL, Khoury RT, Rahbar A.: An unusual manifestation of congenital abdominal aortic coarctation . J Cardiovasc Surg28:740-742, 1987.
65.
Bergqvist D. , Bergentz SE, Ekberg M., et al: Coarctation of the abdominal aorta in elderly patients. Case report and review of the literature. Acta Med Scand223:275-280, 1988.
66.
Blank RH, Connar RG: Coarctation of the abdominal aorta associated with renal artery stenosis . Am Surg39:212-215, 1973.
67.
Bliznak J., Bargainer JD: Coarctation of the abdominal aorta with aneurysm of middle cerebral artery . Am J Roentgenol122:29-32, 1974.
68.
Bloor K., Williams RT: Neurofibromatosis and coarctation of the abdominal aorta with renal artery involvement. Br J Surg50:811-813, 1963.
69.
Bozer AY, Böke E., Saylam A., et al: Infrarenal aortic coarctation. J Cardiovasc Surg14:452-455, 1973.
70.
Brock RC, Graham Ajp: Resection of combined aneurysm and coarctation of the aorta and insertion of a homograft. Guy's Hosp Rep101:207-215, 1952.
71.
Brolin I., Paulin S.: Abnormal communications between splanchnic vessels. Acta Radiol2:460-472, 1964.
72.
Bürger K., Luther B., Mau H.: Die operative Korrektur der atypischen Coarctatio aortae. Zentralbl Chir111:717-724, 1986.
73.
Calabrese E. , Malatino L., Petrillo G., et al: Coarctation of the abdominal aorta and multiple renal artery stenosis. Scand J Thorac Cardiovasc Surg22:87-91, 1988.
74.
Cherif A., Chouach H., Belhani A., et al: Les coarctations de l'aorte abdominale: À propos de 4 observations avec revue de la littérature. Tunisie Med66:759-762, 1988.
75.
Chiesa R., Melissano G., Mariani MA, et al: Coartazione ed ipoplasia dell'aorta addominale. Min Chir46:1197-1204, 1991.
76.
Cooley DA, DeBakey ME: Resection of the thoracic aorta with replacement by homograft for aneurysms and constrictive lesions. J Thorac Surg29:66-102, 1955.
77.
D'Abreu AL, Rob CG, Vollmar JF: Die Coarctatio aortae abdominalis. Langenbecks Arch Klin Chir290:521-546, 1959.
78.
Dillon ML, Postlethwait RW: Coarctation of the abdominal aorta: Report of a case and review of the surgical procedures. South Med J54:295-298, 1961.
79.
Doberneck RC , Varco RL: Congenital coarctation of the abdominal aorta. The Journal-Lancet, June 1968, pp 143-150.
80.
Gerbasi FS, Kibler RS, Margileth AM: Coarctation of the abdominal aorta. A case successfully treated surgically . J Pediatr52:191-198, 1958.
81.
Gordon AS, Conrad JK, Kraner JC: Coarctation of the abdominal aorta. An unusual condition with a new prognosis. Rocky MountainMed J64:51-53, 1967.
82.
Gupta S.: Surgical and hemodynamic considerations in middle aortic syndrome . Thorax34:470-478, 1979.
83.
Gürtler KF, Erbe W.: Coarctatio der Bauchaorta. Mißbildung oder entzündliche Genese? Radiologe18:446-449, 1978.
84.
Guzzetta PC , Potter BM, Kapur S., et al: Reconstruction of the renal artery after unsuccessful percutaneous transluminal angioplasty in children. Am J Surg145:647-651, 1983.
85.
Hejhal L., Hejnal J., Firt P.: Coarctation of the abdominal aorta. J Cardiovasc Surg14:168-177, 1973.
86.
Hipona FA, Jamshidi A.: Coarctation of the abdominal aorta. Am J Roentgenol110:515-519, 1970.
87.
Inada K., Yokoyama T., Nakaya R.: Atypical coarctation of the aorta. Angiology14:506-517, 1963.
88.
Kittredge RD , Anderson JW: Coarctation of the lower thoracic and abdominal aorta. Radiology79:799-803, 1962.
89.
Loose DA, Wang ZG: Surgical treatment of predominantly arterial defects. Int Angiol9:183-188, 1990.
90.
Lurquin P., Masset A., Mendes da Costa P: À propos d'un cas de coarctation de l'aorte abdominale . Acta Chir Belg91:284-287, 1991.
91.
Marçon F., Brice M., Worms AM, et al: Coarctation de l'aorte abdominale. Ann Méd Nancy1159-1170, 1980.
92.
Milloy F., Fell EH: Elongate coarctation of the aorta. Arch Surg78:759-765, 1959.
93.
Morino F., Possati F., Grande A., et al: La coartazione dell'aorta addominale. Min Cardioangiol21:345-348, 1973.
94.
Mugambi M., Silverstein D.: Suprarenal aortic coarctation. Case report. East Afr Med J57:358-361, 1980.
95.
Müller-Wiefel H., Brieler HS, Müller W.: Coarctatio aortae abdominalis mit Beteiligung der Nierenarterien. Thoraxchirurgie21:81-86, 1973.
96.
Nanni GS, Hawkins IF, Alexander JA: Percutaneous transluminal angioplasty of an abdominal aortic coarctation . Am J Roentgenol140:1239-1241, 1983 .
97.
Occhionorelli S., Taddia MC, Romano D., et al: Coartazione sottorenale dell'aorta. Presentazione di un caso clinico. Min Cardioangiol39:303-306, 1991.
98.
Paroni R., Astuni M., Baroni C., et al: Abdominal aortic coarctation inducing aortic occlusion and renovascular hypertension. J Cardiovasc Surg32:770-774, 1991.
99.
Pernod J., Servelle M., Portal A., et al: Les coarctations thoraciques basses. Arch Mal Cœur60:1202-1213, 1967.
100.
Pierach CA , Katkov H.: Coarctation of the abdominal aorta . Vasc Surg6:159-166, 1972.
101.
Pierce WS, Vincent WR, Fitzgerald E., et al: Coarctation of the abdominal aorta with multiple aneurysms. Operative correction. Ann Thorac Surg20:687-693, 1975.
102.
Pistorius MA, Sagan C., Chaillou P., et al: Thrombose de l'aorte révélatice d'une coarctation de l'aorte abdominale sous-rénale. J Mal Vasc19:242-246, 1994.
103.
Robicsek F. , Sanger PW, Daugherty HK: Coarctation of the abdominal aorta diagnosed by aortography: Report of three cases. Ann Surg162:227-233, 1965.
104.
Roques X., Bourdeaud'hui A., Choussat A., et al: Coarctation of the abdominal aorta. Ann Vasc Surg2:138-144, 1988.
105.
Sautter RD , Myers WO, Smullen WA, et al: Tandem coarctations of thoracic and abdominal aorta with intervening hypoplastic thoracic aorta: Treatment with unilateral axillofemoral graft. Ann Thorac Surg23:582-584, 1977.
106.
Schechter C., Angelini P., Treistman B.: Percutaneous balloon catheter angioplasty of coarctation of the abdominal aorta: Report of two cases. Cathet Cardiovasc Diagn11:401-407, 1985.
107.
Scott HW, Dean RH, Boerth R., et al: Coarctation of the abdominal aorta. Pathophysiologic and therapeutic considerations. Ann Surg189:746-757, 1979.
108.
Scully RE, Mark EJ, McNeely BU: Case Records of the Massachusetts General Hospital. Case 19-1986. N Engl J Med314:1304-1311, 1986 .
109.
Sokolic J. , Luetic V., Šuša T., et al: Interrenal coarctation of the abdominal aorta. Texas Heart Inst J11:386-390, 1984.
110.
Søndergaard T., Ottosen P.: Coarctation of the abdominal aorta . Acta Chir Scand283(Suppl):194-199, 1961.
111.
Stansel HC : Complicated renal-artery stenosis. N Engl J Med270:770-776, 1964.
112.
Stokes JM, Wohltmann H., Carlson E.: Coarctation of the abdominal aorta and renal artery stenosis corrected by surgical treatment: The importance of individual renal function tests in selection of proper management. Ann Surg152:856-860, 1960.
113.
Svare J., Burchardt Hansen HJ, Brøns J.: Coarctation of the abdominal aorta. Acta Chir Scand502:104-110, 1980.
114.
Theodorides T.: Hypoplasia of the abdominal aorta. J Cardiovasc Surg20:537-544, 1979.
115.
Thevenet A. , Mary H., Boennec M., et al: Coarctations et dysplasies de l'aorte abdominale. A propos de 9 observations. Ann Chir Thorac Cardiovasc17:187-196, 1978.
116.
Valdez-Davila O., Castaneda-Zuniga WR, Nath PH, et al: Coarctation of the abdommal aorta. Fortschr Röntgenstr130:394-397, 1979.
117.
Vollmar J. : Coarctation aortae abdominalis mit Beteiligung der Viszeralarterien. Akt Chir1:359-368, 1970.
118.
Welsh P., Rosas G., Repetto R., et al: Coarctation of the abdominal aorta. J Cardiovasc Surg1 (Suppl): 642-644, 1973.
119.
Zwaan M., Heidbüchel K., Marienhoff N.: Bluthochdruck bei Neurofibromatose mit rezidivierender Nierenarterienstenose und infrarenaler Aortenkoarktation. Fortschr Röntgenstr154:115-116, 1991.
