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Long term follow-up of patients with aortic arch atresia post recanalization.

AIMS
Aortic arch atresia (AAA) is one of the rarest obstructive defects. Presence of this anomaly in adult age is also uncommon. The typical anatomic feature consists of a complete occlusion of the membranous obstruction resulting in an acquired atresia without flow continuity between proximal and distal segments. This feature is important in determining the feasibility of percutaneous intervention. We present a long term follow up of 19 patients with 'AAA' who underwent successful percutaneous recanalization with covered stents.


METHODS AND RESULTS
Retrospective data of 19 patients (12 male, 63.2%, mean age: 32.2 years ± 18.9 years) diagnosed with 'AAA' treated in five different centers between 1999 to 2017 were collected. All patients underwent percutaneous recanalization by (1) radiofrequency system (RF) (five patients, 26.3%), (2) extra-stiff guide wire (12 patients, 63.2%) and (3) trans-septal needle (two patients, 10.5%). All procedures were subsequently followed by covered stent implantation. Two patients developed complications during the procedure and one of them died. Over a median follow-up of 4.94 years, four (21%) patients were able to wean medications for hypertension. All the patients underwent reassessment for recurrence or restenosis during the follow up. Seven (36.8%) patients underwent successful stent dilatation with a balloon. After the intervention, one patient experienced a late complication, however, one patient died due to an unknown cause believed to be unrelated to the previous recanalization procedure.


CONCLUSIONS
Percutaneous treatment of 'AAA' is feasible with good long-term survival. This study reports the largest case series as per available literature, so far.