How to treat aortic coarctation

Recommendations: Treatment options for aortic coarctation For acute and chronic DeBakey type I and II coarctation aneurysms, surgery as soon as possible, i.e., replacement of the ascending aorta and/or the aortic arch with a prosthetic vessel, is the best option. The long-term outcome, i.e., 5-year survival rate, is more than 80%. For some DeBakey type I coarctation aneurysms (rupture in the descending aorta, thrombus already formed in the false lumen of the ascending aorta) and acute and chronic DeBakey type III coarctation aneurysms, interventional therapy has been developed in recent years, i.e., using stent-type artificial blood vessels to close the rupture so that thrombus can be spontaneously formed in the false lumen of the arteries, which can greatly reduce the mortality rate and complications of the traditional surgery, and it has been the first choice for patients in large central hospitals. The operation is less traumatic, the patient recovers faster, and its application is becoming more and more widespread. Aortic coarctation outcomes Aortic aneurysm surgery is a high-risk procedure. DeBakey type I and II coarctation aneurysms have a surgical success rate of over 90%. In patients with cardiac, pulmonary, renal, or hepatic insufficiency or in elderly patients, the risk of surgery is higher and the mortality rate can be as high as 30%. Stenting of DeBakey III aneurysms is a safe procedure. The operative mortality rate is approximately 5%. The complication rate is about 10%. The natural course of aortic dissection The natural course of aortic dissection is treacherous, with a high mortality rate if not diagnosed and treated promptly. It has been reported that 25% of untreated patients die within 24 hours, 50% within one week, 75% within one month, and 90% within one year. Three quarters of the deaths are due to rupture of the dissection into the pericardium, pericardial occlusion, trachea, bronchus, esophagus, or thoracic hemorrhage. The incidence of rupture of chronic aortic dissection is high, with a 5-year survival rate of 10-15%. Indications for surgical treatment of aortic coarctation Whether it is a coarctation aneurysm of the ascending or descending aorta, surgical or interventional treatment is indicated for any of the following conditions: (1) Acute DeBakey type I and type II aortic coarctation.　　(2) Acute aortic coarctation in patients with pain that cannot be controlled by medication or high blood pressure.　　(3) Symptoms and signs of progressive vital organ (heart, brain, kidney) invasion.