Endovascular management of asymptomatic large descending thoracic aortic aneurysm long after coarctation of aorta repair: a case report

BACKGROUND: Coarctation of the aorta represents 6-8% of congenital heart defects. Surgical repair is often done in infancy, but late complications such as aneurysm formation may be present decades later. Late aneurysm after childhood coarctation repair remains a recognized complication, but surveillance lapses and complex arch branch involvement can delay detection and complicate repair planning. We present a case of a large descending thoracic aortic aneurysm found incidentally over 60 years after initial coarctation repair, a latency period exceeding many reported cases [5]. CASE PRESENTATION: A 62-year-old woman with a history of coarctation repairs at 5 months of age and at 10 years of age presented asymptomatically for echocardiogram evaluation of a cardiac murmur. Computed tomography angiography (CTA) revealed a 7.3 cm saccular aneurysm (length 8.2 cm, width 6.5 cm, depth 7.3 cm) of the distal aortic arch and proximal descending aorta, with the left subclavian artery previously ligated and the left carotid artery originating from the aneurysm sac. She underwent a hybrid repair performed in a single setting: right common carotid-to-left common carotid bypass via retro-pharyngeal tunneling followed by thoracic endovascular aortic repair (TEVAR) with overlapping stent grafts. Angiography confirmed complete exclusion of the aneurysm without endoleak. Follow-up revealed no complications, and the patient remained asymptomatic. CONCLUSIONS: This case underscores the importance of lifelong surveillance in patients with repaired congenital heart disease, even in the absence of symptoms. Evolution of technology with endovascular repair has provided less invasive options for management of complex aneurysms resulting after repair of aortic coarctation. This case report demonstrates surveillance gaps after repair of thoracic aortic coarctation.