Papers of the Week

Coral reef aorta (CRA) is a rare condition featured by rock-hard calcifications that grow into the lumen of thoracoabdominal aorta. Patients suffering from CRA may present severe downstream ischemic and embolic events involving the viscera and the lower limbs. In these patients open surgical repair is the first choice of treatment. We present a case of a 70-year-old woman with acute presentation of bilateral limb ischemia and abdominal pain. Angio-CT scan showed the sub-occlusion of the distal thoracic aorta due to a severe calcified coarctaction with intraluminal thrombosis, a chronic occlusion of the superior mesenteric and celiac trunk arteries, an hypertrophic inferior mesenteric artery associated with signs of partial left kidney ischemia. The patient underwent urgent endovascular repair. A soft dilatation of the coarctation using a 7mm no-compliant balloon was initially performed; a 21 mm conformable thoracic stent-graft was subsequently deployed and increasingly dilated using progressively larger angioplasty balloons. The procedure was uneventful and the aortic gradient was reduced to zero. Postoperative CT scan revealed the proper deployment of the graft with no residual stenosis. Endovascular approach with covered thoracic stent-graft could be an accurate technique to treat CRA in the emergency setting. It allows for a primary protected balloon angioplasty and, in case of aortic-graft recoiling, a subsequent placement of covered or uncovered balloon expandable stent graft can be safely and easily performed.