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Peer-reviewedCC BY-NC-ND 4.0JACC Case Reports

Endoarch Repair of Ruptured Extra-Anatomic Ascending to Descending Bypass Graft in Hypoplastic Arch With Coarctation

  • Nikita Zadneulitca1
  • Bryant Mclafferty2
  • Brent Demanby1
  • Nicholas C. Eglitis3
  • Rhusheet P. Patel2
  • Castigliano M. Bhamidipati1
  1. 1Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
  2. 2Division of Vascular Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
  3. 3Division of Cardiac Anesthesia, Department of Anesthesia, Oregon Health and Science University, Portland, Oregon, USA
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Abstract

Background: Hypoplastic arch and residual coarctation are treated with ascending to descending extra-anatomic bypasses and are challenging to manage.

Case Summary: A 36-year-old woman with several sternotomies had undergone ascending to descending extra-anatomic bypass as a neonate. She experienced blunt force trauma to her chest, and significant delay in diagnosis led to decompensation. A nondisplaced fracture lacerated the aortic graft and led to a contained rupture and bacteremia. She underwent left thoracotomy and complex thoracic endovascular aortic repair. Six weeks of antibiotics and careful conservative management led to a safe outcome.

Discussion: Management of a ruptured extra-anatomic bypass in the setting of bacteremia with thoracic endovascular aortic repair is controversial. Given multiple prior sternotomies, the degree of required tissue debridement, and anticipated lifelong antibiotic suppression, an initial endovascular approach seemed warranted. Unconventional approaches to complex adult congenital heart disease (ACHD) lesions are necessary to increase longevity and mitigate disease.

Take-Home Messages: Patients with ACHD require early recognition with a high index of suspicion. Endovascular repair in ACHD arch pathology should be considered.

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Cite

BibTeXRIS
BibTeX
@article{zadneulitca2026endoarch,
  title = {{Endoarch Repair of Ruptured Extra-Anatomic Ascending to Descending Bypass Graft in Hypoplastic Arch With Coarctation}},
  author = {Nikita Zadneulitca and Bryant Mclafferty and Brent Demanby and Nicholas C. Eglitis and Rhusheet P. Patel and Castigliano M. Bhamidipati},
  journal = {JACC Case Reports},
  year = {2026},
  month = aug,
  doi = {10.1016/j.jaccas.2026.110034},
  url = {https://doi.org/10.1016/j.jaccas.2026.110034},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Endoarch Repair of Ruptured Extra-Anatomic Ascending to Descending Bypass Graft in Hypoplastic Arch With Coarctation
AU  - Nikita Zadneulitca
AU  - Bryant Mclafferty
AU  - Brent Demanby
AU  - Nicholas C. Eglitis
AU  - Rhusheet P. Patel
AU  - Castigliano M. Bhamidipati
PY  - 2026
DA  - 2026/08/28
JO  - JACC Case Reports
DO  - 10.1016/j.jaccas.2026.110034
UR  - https://doi.org/10.1016/j.jaccas.2026.110034
AB  - Background: Hypoplastic arch and residual coarctation are treated with ascending to descending extra-anatomic bypasses and are challenging to manage.  Case Summary: A 36-year-old woman with several sternotomies had undergone ascending to descending extra-anatomic bypass as a neonate. She experienced blunt force trauma to her chest, and significant delay in diagnosis led to decompensation. A nondisplaced fracture lacerated the aortic graft and led to a contained rupture and bacteremia. She underwent left thoracotomy and complex thoracic endovascular aortic repair. Six weeks of antibiotics and careful conservative management led to a safe outcome.  Discussion: Management of a ruptured extra-anatomic bypass in the setting of bacteremia with thoracic endovascular aortic repair is controversial. Given multiple prior sternotomies, the degree of required tissue debridement, and anticipated lifelong antibiotic suppression, an initial endovascular approach seemed warranted. Unconventional approaches to complex adult congenital heart disease (ACHD) lesions are necessary to increase longevity and mitigate disease.  Take-Home Messages: Patients with ACHD require early recognition with a high index of suspicion. Endovascular repair in ACHD arch pathology should be considered.
SN  - 2666-0849
ER  -