Simultaneous open surgical treatment of aortic coral reef and Leriche syndrome: case report and literature review

The coral reef aorta (CRA) is a rare syndrome commonly referred to a distribution of calcified plaques in the visceral part of the aorta. Since those plaques can cause malperfusion of the lower limbs, visceral ischemia or renovascular hypertension, surgical treatment is recommended. Transaortic endarterectomy is accepted as a standard repair and it is often performed through an extensive thoraco-abdominal approach. CRA has been reported in association with polidistrectual atherosclerotic disease, such as Leriche syndrome. When these two conditions coexist, surgical invasivity increases raising several issues concerning the type of surgical access as well as the revascularization techniques. We report the case of a patient with CRA and Leriche syndrome treated by simultaneous aortic endarterectomy and aortibifemoral bypass at our institution. Intervention was performed through left lumbotomy at 10th intercostal space extended by a left pararectal abdominal incision with section of 11th rib. Through extraperitoneal access visceral vessels were isolated. Aortic cross clamping was performed at supraceliac and infrarenal levels and a longitudinal arteriotomy was performed on the posterolateral wall of visceral aorta for an overall 4 cm extension. Aortic endarterectomy was then performed and complete plaque excision was easily achieved. SMA angioplasty was then performed by a DeBakey dilator, gaining an optimal backflow. The aortotomy was then closed with running 3-0 polypropilene suture. Subsequently, through a trans-peritoneal access an aortobifemoral bypass was performed by a dacron knitted graft. Post-operative course was uneventful. At a 6 months follow-up the patient is in good clinical condition with normal patency of visceral vessels.