Aortic Resection and Replacement for Coral Reef Aorta Involving Severe Obstructive Calcification: A Case Report

TL;DR

A 74-year-old woman with a rare aortic condition called coral reef aorta underwent successful surgical replacement of her calcified aorta with a prosthetic graft, leading to symptom improvement and no recurrence after one year.

Contribution

This case report presents a successful surgical approach for treating coral reef aorta using graft replacement over endovascular options.

Findings

The patient showed improvement in intermittent claudication after aortic resection and graft replacement.

No recurrence of symptoms was observed during the one-year follow-up period.

Prosthetic graft replacement was found to be more suitable than endarterectomy or bypass for this condition.

Abstract

Coral reef aorta (CRA) is a rare aortic condition characterized by calcifications protruding into the lumen, resulting in severe stenosis that can lead to symptoms such as intermittent claudication in the lower limbs and intestinal ischemia. Some patients may progress to fatal conditions such as intestinal ischemia or congestive heart failure. A 74-year-old female was referred to our hospital with intermittent claudication and severe calcification of the abdominal aorta. Computed tomography (CT) scans revealed extensive calcification of the infrarenal abdominal aorta, with protrusions into the lumen, resulting in severe stenosis. After a thorough discussion with catheter interventionists, we concluded that graft replacement was a reasonable option, offering a lower risk of re-intervention compared with endovascular surgery. Considering the sites for aortotomy and anastomosis, we assessed that prosthetic graft replacement was more suitable than endarterectomy or bypass. Under general anesthesia, the patient underwent a laparotomy through a midline abdominal incision. The calcified aorta was resected and reconstructed with a prosthetic graft. She showed improvement in intermittent claudication postoperatively, and she was discharged home on postoperative day 13. No recurrence of symptoms has been observed during the one-year follow-up period.

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