Ascending aorta to iliac artery bypass in coral reef aorta with multidrug resistant hypertension and worsening renal function

Coral reef aorta is a rare condition characterized by heavily calcified atherosclerotic disease that involves the juxtarenal aorta, leading to potentially life-threatening complications (congestive heart failure, refractory hypertension, and visceral or limb ischemia). Here, we report the case of an elderly woman with resistant hypertension and worsening kidney function with a solitary right kidney, who underwent successful open surgical repair using the ascending aorta as an inflow source to a bypass graft to the renal, mesenteric and iliac arteries. This approach provides an effective and durable option for difficult coral reef aorta cases not amenable to other less invasive approaches.