Tilea et al. Journal of Medical Case Reports 2012, 6:255 http://www.jmedicalcasereports.com/content/6/1/255 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Hybrid repair of a very late, post-aortic coarctation surgery thoracic aneurysm: a case report Ioan Tilea1,2, Laszlo Hadadi3, Razvan C Serban3 and Brindusa Tilea2,4* Abstract Introduction: Local aneurysms after surgical repair of coarctation of the aorta occur mainly in patients surgically treated by Dacron patch plasty during adulthood. The management of these patients is always problematic, with frequent complications and increased mortality rates. Percutaneous stent-graft implantation avoids the need for surgical reintervention. Case presentation: We report a case involving the hybrid treatment by stent-graft implantation and transposition of the left subclavian artery to the left common carotid artery of an aneurysmal dilatation of the thoracic aorta that occurred in a 64-year-old Caucasian man, operated on almost 40 years earlier with a Dacron patch plasty for aortic coarctation. Our patient presented to our facility for evaluation with back pain and shortness of breath after minimal physical effort. A physical examination revealed stony dullness to percussion of the left posterior thorax, with no other abnormalities. The results of chest radiography, followed by contrast-enhanced computed tomography and aortography, led to a diagnosis of giant aortic thoracic aneurysm. Successful treatment of the aneurysm was achieved by percutaneous stent-graft implantation combined with transposition of the left subclavian artery to the left common carotid artery. His post-procedural recovery was uneventful. Three months after the procedure, computed tomography showed complete thrombosis of the excluded aneurysm, without any clinical signs of left lower limb ischemia or new onset neurological abnormalities. Conclusions: Our patient’s case illustrates the clinical outcomes of surgical interventions for aortic coarctation. However, the very late appearance of a local aneurysm is rather unusual. Management of such cases is always difficult. The decision-making should be multidisciplinary. A hybrid approach was considered the best solution for our patient. Keywords: Aortic aneurysm, Aortic coarctation, Aortic stent-graft Introduction Coarctation of the aorta is a relatively frequent congenital cardiovascular disease, accounting for approximately 4% of all congenital cardiovascular abnormalities [1]. The usual approach is the surgical correction of the anomaly. Despite high initial success rates, more than 9% of patients develop late complications, such as systemic hypertension, premature coronary artery disease, aortic * Correspondence: brindusa_tilea@yahoo.com 2University of Medicine and Pharmacy of Targu Mures, 38 Gheorghe Marinescu St, Targu Mures 540139, Romania 4Emergency Clinical County Hospital, Department of Infectious Diseases, 50 Gheorghe Marinescu St, 540136, Targu Mures, Romania Full list of author information is available at the end of the article valve abnormalities, aneurysm formation, or recoarctation [2,3]. Post-surgical aneurysms are described after sub- clavian flap angioplasty in 17% of cases, patch angioplasty in 14% of cases, interposition graft repair in 6% of cases and, occasionally, after end-to-end anastomosis in patients with persistent systemic hypertension [4,5]. Post-surgical aneurysms are particularly frequent after Dacron patch plasty performed in adulthood. Late occurrence of aortic aneurysms after surgical correction of aortic coarctation carries a significant risk of rupture and is associated with high mortality rates. Management of such patients is always challenging. Conservative treatment has unpredict- able short-term results. A single-center study reported a 100% rate of rupture within 15 years [6]. Surgical © 2012 Tilea et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.