Coral Reef Aorta
Özet
Suprarenal aortta ateroskleroza bağlı lokal obstrüksiyonlara nadiren rastlanılmakta olup, genellikle vaka raporları şeklinde karşımıza çıkmaktadır. Coral Reef Aorta, aortun suprarenal segmentinde, lümene doğru uzanım gösteren, tıkayıcı, kaya sertliğinde, yoğun kalsifiye-aterosklerotik, polipoid lezyonlar olarak tanımlanmaktadır. Lezyonlar, genellikle aortun posterior duvarına lokalize olmaya meyilli olup, tanı için abdominal aortun hem anteroposterior hem de lateral projeksiyonlarda incelendiği tam bir aortografi gereklidir. Etiyoloji ve patogenez halen belirsizliğini korumakla beraber, plak rüptürü sonucu gelişen fibrin-trombosit trombüsünün kalsifikasyonunun bu lezyona yol açabileceği öne sürülmüştür. Olası diğer hipotezler, eski diseksiyonların kalsifikasyonu ve aşırı ektopik kalsifikasyona yol açan düzenleyici moleküllerdeki kusurlardır. Literatürde bildirilen vakaların ortalama yaşı 59 civarında olup, diğer tıkayıcı arter hastalıklarından 1-2 dekat daha erken görülmektedir. Yoğun sigara tüketimi, bu hasta grubunda göze çarpan en belirgin risk faktörüdür. Başlıca semptom ve bulgular, kladikasyo intermittans, dirençli renovasküler hipertansiyon ve intestinal anjinadır. Konvansiyonel tedavi yaklaşımı, açık transaortik tromboendarterektomidir. Cerrahi tedavide operatif mortalite %8,7-11,6 gibi yüksek oranlarda olup, laparoskopik tromboendarterektomi ve endovasküler girişim (balon anjiyoplasti veya aortik stent) diğer tedavi seçenekleridir. Vaka serilerinde, endovasküler girişimler, daha düşük perioperatif risk ile ilişkili görülmekle birlikte, daha lokalize lezyona sahip, uygun anatomiye sahip az sayıda seçilmiş hasta için uygun bir yaklaşımdır. Optimal tedavi yaklaşımının seçimi bireyselleştirilmeli ve karar multidisipliner bir ekip tarafından verilmelidir.
Local obstructions due to atherosclerosis in the suprarenal aorta are rarely encountered and usually appear in case reports. Coral Reef Aorta is defined as occlusive, rock-hard, densely calcified-atherosclerotic, polypoid lesions in the suprarenal segment of the aorta, extending towards the lumen. Lesions tend to be localized to the posterior wall of the aorta, and diagnosis requires a complete aortography in which the abdominal aorta is examined in both anteroposterior and lateral projections. Although the etiology and pathogenesis remain unclear, it has been suggested that calcification of the fibrin-platelet thrombus that develops as a result of plaque rupture may cause this lesion. Other possible hypotheses are calcification of old dissections and defects in regulatory molecules leading to excessive ectopic calcification. The average age of cases reported in the literature is around 59 years old, and it occurs 1-2 decades earlier than other occlusive arterial diseases. Heavy smoking consumption is the most prominent risk factor in this patient group. The main symptoms and signs are claudication intermittent, resistant renovascular hypertension and intestinal angina. The conventional treatment approach is open transaortic thromboendarterectomy. Operative mortality rates in surgical treatment are as high as 8.7-11.6%, laparoscopic thromboendarterectomy and endovascular intervention (balloon angioplasty or aortic stent) are other treatment options. In case series, endovascular interventions appear to be associated with lower perioperative risk, but are an appropriate approach for a small number of selected patients with more localized lesions and appropriate anatomy. The choice of the optimal treatment approach should be individualized and the decision should be made by a multidisciplinary team.
Referanslar
Minnee RC, Idu MM, Balm R. Coral Reef Aorta: Case Reports and Review of the Literature. EJVES Extra. 01 Mart 2005;9(3):39-43.
Grotemeyer D, Pourhassan S, Rehbein H, et al. The coral reef aorta - a single centre experience in 70 patients. Int J Angiol. 2007;16(3):98-105.
Qvarfordt PG, Reilly LM, Sedwitz MM, et al. “Coral reef” atherosclerosis of the suprarenal aorta: a unique clinical entity. J Vasc Surg. Kasım 1984;1(6):903-9.
Schechter DC. “Coral reef” atherosclerosis of the suprarenal aorta. J Vasc Surg. Nisan 1986;3(4):679-80.
Sako Y. Arteriosclerotic occlusion of the midabdominal aorta. Surgery. Mayıs 1966;59(5):709-12.
Kopani K, Liao S, Shaffer K. The Coral Reef Aorta: Diagnosis and Treatment Following CT. Radiol Case Rep. 2009;4(1):209.
Schlieper G, Grotemeyer D, Aretz A, et al. Analysis of calcifications in patients with coral reef aorta. Ann Vasc Surg. Nisan 2010;24(3):408-14.
Peillon C, Morlet C, Laissy JP, et al. Endoaortic calcific proliferation of the upper abdominal aorta. Ann Vasc Surg. Nisan 1989;3(2):181-6.
Oberstein A, Zocholl G, Schmied W. ["Coral reef" arteriosclerosis: computed tomographic and angiographic findings]. Rontgenblatter. Aralık 1990;43(12):536-8.
Troncone M, Dagenais F. Commentary: Conquering the great barrier: Coral reef aorta. JTCVS Tech. Nisan 2022;12:21-2.
Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 01 Kasım 2014;35(41):2873-926.
Schulte KM, Reiher L, Grabitz L, et al. Coral reef aorta: a long-term study of 21 patients. Ann Vasc Surg. Kasım 2000;14(6):626-33.
Combe J, Huart JY, Kantelip B, et al. [Amyloidosis of a coral reef infrarenal aorta]. J Mal Vasc. Mart 1997;22(1):43-7.
Charnsangavej C. Intraluminal calcification and occlusion of the abdominal aorta above the renal arteries. Cardiovasc Intervent Radiol. 1981;4(4):242-4.
Baldaia L, Antunes LF, Silva M, et al. Coral Reef Aorta: Literature Review and Analysis of the published cases in the last 20 years. Ann Vasc Surg. 14 Temmuz 2023;S0890-5096(23)00508-3.
Satsu T, Saga T, Kaneda T, et al. Congestive heart failure due to coral reef thoracoabdominal aorta. Interact Cardiovasc Thorac Surg. Aralık 2011;13(6):684-5.
Gd R, La K. Blue toe syndrome from a “coral reef” aorta. Annals of vascular surgery [Internet]. Kasım 1995 [a.yer 03 Ağustos 2023];9(6). Erişim adresi: https://pubmed.ncbi.nlm.nih.gov/8746834/
Ishigaki T, Matsuda H, Henmi S, et al. Severe Obstructive Calcification of the Descending Aorta: A Case Report of “Coral Reef Aorta”. Ann Vasc Dis. 25 Haziran 2017;10(2):155-8.
Borgis KJ, Ollrogge C, Gmelin E. [Suprarenal aortic sclerosis: coral-reef arteriosclerosis. Case report and literature review]. Rofo. Aralık 1986;145(6):721-3.
Pulli R, Dorigo W, Azas L, et al. «Coral Reef» Atherosclerosis of Suprarenal Aorta: Case Report and Literatuve Review. EJVES Extra [İnternet]. 2002 [a.yer 06 Ağustos 2023];1(6). Erişim adresi: https://cyberleninka.org/article/n/444908
Cappeller WA, Sutter T, Taute BM. Korallenriffatherosklerose kalzifizierte stenose der throrakoabdominalen aorta. Gefasschirurgie 1998;3:170–175.
Policha A, Moudgill N, Eisenberg J, et al. Coral reef aorta: case report and review of the literature. Vascular. Ağustos 2013;21(4):251-9.
Belczak SQ, Sincos IR, Aun R, et al. Coral reef aorta, emergency surgical: case report and literature review. Einstein (Sao Paulo). Nisan 2014;12(2):237-41.
Sagban AT, Grotemeyer D, Rehbein H, et al. [Occlusive aortic disease as coral reef aorta--experience in 80 cases]. Zentralbl Chir. Ekim 2010;135(5):438-44.
Chag MC, Thakre AA. Novel use of intravascular lithotripsy for coral reef aorta: a case report. Eur Heart J Case Rep. Nisan 2021;5(4):ytab102.
Holfeld J, Gottardi R, Zimpfer D, et al. Treatment of symptomatic coral reef aorta by endovascular stent-graft placement. Ann Thorac Surg. Mayıs 2008;85(5):1817-9.
Gatta E, Berretta P, Pagliariccio G, et al. Emergency Endovascular Treatment of Coral Reef Aorta with an Unconventional Technique. Ann Vasc Surg. Şubat 2020;63:456.e5-456.e9.
de Vries JPPM, van Den Heuvel D a. F, Vos JA, et al. Freedom from secondary interventions to treat stenotic disease after percutaneous transluminal angioplasty of infrarenal aorta: long-term results. J Vasc Surg. Şubat 2004;39(2):427-31.
Myouchin K, Takayama K, Wada T, et al. Treatment of Coral Reef Aorta by Endovascular VIABAHN VBX Balloon-Expandable Stent-Graft Placement. Ann Vasc Dis. 25 Eylül 2021;14(3):244-8.
Nishio R, Matsumoto D, Noiri JI, et al. Balloon angioplasty for uncontrollable hypertension caused by coral reef aorta: A case report. J Cardiol Cases. Aralık 2021;24(6):255-8.
Bosanquet DC, Wood A, Williams IM. Treatment of symptomatic coral reef aorta with an uncovered stent graft. Vascular. Ekim 2015;23(5):555-7.
Piazza M, Squizzato F, De Massari C, et al. Intravascular lithotripsy angioplasty for treatment of atherosclerotic coral-reef occlusion of the infrarenal aorta and its bifurcation. J Vasc Surg Cases Innov Tech. Mart 2023;9(1):101106.
Sekar N, Manoj S, Jagan J. Suprarenal Aortic Occlusion Due to Coral Reef Calcification: Successful Endovascular Management Assisted by Intravascular Lithotripsy and Visceral Protection. J Endovasc Ther. 02 Temmuz 2022;15266028221108660.
Referanslar
Minnee RC, Idu MM, Balm R. Coral Reef Aorta: Case Reports and Review of the Literature. EJVES Extra. 01 Mart 2005;9(3):39-43.
Grotemeyer D, Pourhassan S, Rehbein H, et al. The coral reef aorta - a single centre experience in 70 patients. Int J Angiol. 2007;16(3):98-105.
Qvarfordt PG, Reilly LM, Sedwitz MM, et al. “Coral reef” atherosclerosis of the suprarenal aorta: a unique clinical entity. J Vasc Surg. Kasım 1984;1(6):903-9.
Schechter DC. “Coral reef” atherosclerosis of the suprarenal aorta. J Vasc Surg. Nisan 1986;3(4):679-80.
Sako Y. Arteriosclerotic occlusion of the midabdominal aorta. Surgery. Mayıs 1966;59(5):709-12.
Kopani K, Liao S, Shaffer K. The Coral Reef Aorta: Diagnosis and Treatment Following CT. Radiol Case Rep. 2009;4(1):209.
Schlieper G, Grotemeyer D, Aretz A, et al. Analysis of calcifications in patients with coral reef aorta. Ann Vasc Surg. Nisan 2010;24(3):408-14.
Peillon C, Morlet C, Laissy JP, et al. Endoaortic calcific proliferation of the upper abdominal aorta. Ann Vasc Surg. Nisan 1989;3(2):181-6.
Oberstein A, Zocholl G, Schmied W. ["Coral reef" arteriosclerosis: computed tomographic and angiographic findings]. Rontgenblatter. Aralık 1990;43(12):536-8.
Troncone M, Dagenais F. Commentary: Conquering the great barrier: Coral reef aorta. JTCVS Tech. Nisan 2022;12:21-2.
Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 01 Kasım 2014;35(41):2873-926.
Schulte KM, Reiher L, Grabitz L, et al. Coral reef aorta: a long-term study of 21 patients. Ann Vasc Surg. Kasım 2000;14(6):626-33.
Combe J, Huart JY, Kantelip B, et al. [Amyloidosis of a coral reef infrarenal aorta]. J Mal Vasc. Mart 1997;22(1):43-7.
Charnsangavej C. Intraluminal calcification and occlusion of the abdominal aorta above the renal arteries. Cardiovasc Intervent Radiol. 1981;4(4):242-4.
Baldaia L, Antunes LF, Silva M, et al. Coral Reef Aorta: Literature Review and Analysis of the published cases in the last 20 years. Ann Vasc Surg. 14 Temmuz 2023;S0890-5096(23)00508-3.
Satsu T, Saga T, Kaneda T, et al. Congestive heart failure due to coral reef thoracoabdominal aorta. Interact Cardiovasc Thorac Surg. Aralık 2011;13(6):684-5.
Gd R, La K. Blue toe syndrome from a “coral reef” aorta. Annals of vascular surgery [Internet]. Kasım 1995 [a.yer 03 Ağustos 2023];9(6). Erişim adresi: https://pubmed.ncbi.nlm.nih.gov/8746834/
Ishigaki T, Matsuda H, Henmi S, et al. Severe Obstructive Calcification of the Descending Aorta: A Case Report of “Coral Reef Aorta”. Ann Vasc Dis. 25 Haziran 2017;10(2):155-8.
Borgis KJ, Ollrogge C, Gmelin E. [Suprarenal aortic sclerosis: coral-reef arteriosclerosis. Case report and literature review]. Rofo. Aralık 1986;145(6):721-3.
Pulli R, Dorigo W, Azas L, et al. «Coral Reef» Atherosclerosis of Suprarenal Aorta: Case Report and Literatuve Review. EJVES Extra [İnternet]. 2002 [a.yer 06 Ağustos 2023];1(6). Erişim adresi: https://cyberleninka.org/article/n/444908
Cappeller WA, Sutter T, Taute BM. Korallenriffatherosklerose kalzifizierte stenose der throrakoabdominalen aorta. Gefasschirurgie 1998;3:170–175.
Policha A, Moudgill N, Eisenberg J, et al. Coral reef aorta: case report and review of the literature. Vascular. Ağustos 2013;21(4):251-9.
Belczak SQ, Sincos IR, Aun R, et al. Coral reef aorta, emergency surgical: case report and literature review. Einstein (Sao Paulo). Nisan 2014;12(2):237-41.
Sagban AT, Grotemeyer D, Rehbein H, et al. [Occlusive aortic disease as coral reef aorta--experience in 80 cases]. Zentralbl Chir. Ekim 2010;135(5):438-44.
Chag MC, Thakre AA. Novel use of intravascular lithotripsy for coral reef aorta: a case report. Eur Heart J Case Rep. Nisan 2021;5(4):ytab102.
Holfeld J, Gottardi R, Zimpfer D, et al. Treatment of symptomatic coral reef aorta by endovascular stent-graft placement. Ann Thorac Surg. Mayıs 2008;85(5):1817-9.
Gatta E, Berretta P, Pagliariccio G, et al. Emergency Endovascular Treatment of Coral Reef Aorta with an Unconventional Technique. Ann Vasc Surg. Şubat 2020;63:456.e5-456.e9.
de Vries JPPM, van Den Heuvel D a. F, Vos JA, et al. Freedom from secondary interventions to treat stenotic disease after percutaneous transluminal angioplasty of infrarenal aorta: long-term results. J Vasc Surg. Şubat 2004;39(2):427-31.
Myouchin K, Takayama K, Wada T, et al. Treatment of Coral Reef Aorta by Endovascular VIABAHN VBX Balloon-Expandable Stent-Graft Placement. Ann Vasc Dis. 25 Eylül 2021;14(3):244-8.
Nishio R, Matsumoto D, Noiri JI, et al. Balloon angioplasty for uncontrollable hypertension caused by coral reef aorta: A case report. J Cardiol Cases. Aralık 2021;24(6):255-8.
Bosanquet DC, Wood A, Williams IM. Treatment of symptomatic coral reef aorta with an uncovered stent graft. Vascular. Ekim 2015;23(5):555-7.
Piazza M, Squizzato F, De Massari C, et al. Intravascular lithotripsy angioplasty for treatment of atherosclerotic coral-reef occlusion of the infrarenal aorta and its bifurcation. J Vasc Surg Cases Innov Tech. Mart 2023;9(1):101106.
Sekar N, Manoj S, Jagan J. Suprarenal Aortic Occlusion Due to Coral Reef Calcification: Successful Endovascular Management Assisted by Intravascular Lithotripsy and Visceral Protection. J Endovasc Ther. 02 Temmuz 2022;15266028221108660.
