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Background <p>Interrupted aortic arch (IAA) is a severe congenital anomaly typically fatal in infancy without surgical intervention. Adult presentation of isolated IAA is exceedingly rare and usually relies on an extensive compensatory collateral vascular network.</p> Case presentation <p>We present the case of a 25-year-old man who presented with malignant hypertension. Computed tomography angiography with 3D reconstruction revealed complete occlusion of the aortic arch distal to the left subclavian artery, accompanied by a massive collateral circulation derived from dilated intercostal and internal mammary arteries. Open surgical repair was performed via a left posterolateral thoracotomy. Intraoperative findings identified an atretic fibrous cord at the occlusion site, suggesting an extreme progression of severe coarctation of the aorta into an acquired interruption. An 18-mm Dacron tube graft was successfully interposed between the arch and descending aorta. Crucially, this was performed as an off-pump extra-anatomic bypass without cardiopulmonary bypass. The postoperative course was uneventful. At 4 months, his blood pressure was significantly improved, though a small residual gradient persisted.</p> Conclusion <p>This case suggests that severe coarctation can progress to an acquired atresia mimicking IAA. Off-pump extra-anatomic bypass is a safe and effective strategy expected to alleviate refractory hypertension and prevent long-term cardiovascular and cerebrovascular complications in heavily collateralized adults.</p>

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Surgical management of an acquired aortic interruption suspected from severe aortic coarctation in an adult with massive collaterals

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月17日

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  • Min Qiu,
  • Chengyi Hui,
  • Qikun Zhu,
  • Zewen Chen,
  • Yong Zhang,
  • Shusheng Wen,
  • Hujun Cui

摘要

Background

Interrupted aortic arch (IAA) is a severe congenital anomaly typically fatal in infancy without surgical intervention. Adult presentation of isolated IAA is exceedingly rare and usually relies on an extensive compensatory collateral vascular network.

Case presentation

We present the case of a 25-year-old man who presented with malignant hypertension. Computed tomography angiography with 3D reconstruction revealed complete occlusion of the aortic arch distal to the left subclavian artery, accompanied by a massive collateral circulation derived from dilated intercostal and internal mammary arteries. Open surgical repair was performed via a left posterolateral thoracotomy. Intraoperative findings identified an atretic fibrous cord at the occlusion site, suggesting an extreme progression of severe coarctation of the aorta into an acquired interruption. An 18-mm Dacron tube graft was successfully interposed between the arch and descending aorta. Crucially, this was performed as an off-pump extra-anatomic bypass without cardiopulmonary bypass. The postoperative course was uneventful. At 4 months, his blood pressure was significantly improved, though a small residual gradient persisted.

Conclusion

This case suggests that severe coarctation can progress to an acquired atresia mimicking IAA. Off-pump extra-anatomic bypass is a safe and effective strategy expected to alleviate refractory hypertension and prevent long-term cardiovascular and cerebrovascular complications in heavily collateralized adults.