In Reply to: Case 1097_06 --Coral reef aorta posted by Editor on October 14, 1997 at 15:46:48:
In regards to the extensive calcifications in the aorta ("coral reef"), this patient presents with an interesting dilemma. Typically these polypoid plaques are so rough and irregular and heavily calcified that endovascular therapy is not an attractive option. If the patient were microembolizing, our first option would be thoracotomy and endarterectomy of the aortic wall. For less polypoid plaques, it is conceivable you could place an endovascular stent-graft with the goal of "covering" the irregular surface with a smooth polyester or PTFE graft. In this particular case, if the patient had distal exertional ischemia due to coarctation-like physiology, one could potentially place a balloon expandable stent following pre-dilation at the site of maximal stenosis. The stent would not deploy as a nice, smooth cylinder, but it could reduce the pressure gradient enough to eliminate claudication. The etiology is unkown but in our practice, this type of patient presents once or twice a year. I guess I would refer the patient to Northwestern!