Endovascular Repair of Thoracic Aortic Atresia in Adults: A Narrative Review of a Rare Entity and Emerging Technique

Figures

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  Figure 1. The 12-lead electrocardiogram (ECG) of a patient diagnosed with aortic atresia—sinus rhythm, a heart rate of 88 bpm, and suggestive signs of left ventricular hypertrophy (LVH)—strain pattern in I, II, aVL, aVF, V5, V6.

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  Figure 2. Transthoracic echocardiographic aspect. (A). Parasternal long-axis view at the level of the left ventricle (LV)—significant left ventricular hypertrophy (LVH) with normal morphology of the aortic valve (AV) and mitral valve (MV). (B). Parasternal short-axis view at the level of the papillary muscles, confirming left ventricular hypertrophy (LVH) without evidence of pericardial effusion. (C). Apical four-chamber view further highlighting pronounced left ventricular hypertrophy (LVH). (D). Suprasternal window showing the emergence of the left common carotid artery and left subclavian artery, followed by abrupt narrowing and total occlusion of the descending thoracic aorta.

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  Figure 3. (A,B). Computed tomography angiography with three-dimensional reconstruction identified an atretic segment in the descending thoracic aorta (dashed circle). (C). Computed tomography angiography with three-dimensional reconstruction demonstrating a well-developed collateral circulation between the proximal and distal portions of the atretic aortic segment; (D). Sagittal view showing a proximal aortic diameter of 1.71 cm, a descending aortic diameter of 1.12 cm, an atretic segment measuring approximately 2.5 cm in length, and a stent landing zone of 3.53 cm.

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  Figure 4. (A). Antegrade injection through an MPA2 6F catheter at the level of the aortic arch, and retrograde injection through a Pigtail 6F catheter at the level of the descending thoracic aorta, distal to the atretic segment. No patent lumen is observed within the atretic segment, which extends over approximately 35 mm. (B). A JR 6F guiding catheter is positioned at the level of the atretic segment. The Confianza Pro guidewire is gradually advanced through the atretic zone, extending distally beyond it. (C). Injection at the aortic level confirms the recanalization of the atretic segment. The BMW 300 guidewire, introduced via the left brachial approach through the left subclavian artery, successfully crosses the coarctated segment and is externalized at the right femoral access site. (D). The stent is positioned at the level of the coarctated segment. The D’Vill introducer is retracted distal to the coarctation site. A contrast injection via the Pigtail catheter is performed to confirm the correct positioning of the stent’s proximal end relative to the left subclavian artery. (E). A waist persistence is observed in the mid-section of the stent, indicating residual narrowing. A…

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  Figure 5. Six-month follow-up imaging after endovascular treatment of thoracic aortic atresia. (A) Sagittal reconstruction of contrast-enhanced computed tomography (CT) demonstrates patency of the thoracic aortic stent-graft with preserved alignment and no evidence of endoleak. (B) A three-dimensional volume-rendered CT image confirms the proper stent position and unobstructed aortic flow, with no signs of graft migration or stenosis.