Endovascular Management of Asymptomatic Large Descending Thoracic Aortic Aneurysm After Coarctation of Aorta Repair: A Case Report

Abstract 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 present decades later. We present a case of a large descending thoracic aortic aneurysm found incidentally over 60 years after initial coarctation repair. Case Presentation A 62-year-old woman with a history of coarctation repairs at 5 months and 10 years presented asymptomatically for echocardiogram evaluation of a cardiac murmur. CTA revealed a 7.3 cm saccular aneurysm 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 two-part procedure in a single setting: carotid-to-carotid bypass via retro-pharyngeal tunneling followed by 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 cardiology follow-up in patients with repaired congenital heart disease, even in the absence of symptoms. Proper counseling and risk stratification could aid in early detection of late complications such as thoracic aortic aneurysm. Endovascular repair with adjunct carotid bypass provides a safe and effective solution in complex anatomical cases.