外科修复的类型取决于狭窄的长度,其方法可能为端对端吻合术、有补片填充的弓部重建或旁路移植。
对于有非连续性狭窄的儿童和成人患者,可对其进行有支架或无支架置入的经皮血管成形术这一恰当的治疗方法来替代外科手术。[24]Shah L, Hijazi Z, Sandhu S, et al. Use of endovascular stents for the treatment of coarctation of the aorta in children and adults: immediate and midterm results. J Invasive Cardiol. 2005 Nov;17(11):614-8.http://www.ncbi.nlm.nih.gov/pubmed/16264209?tool=bestpractice.com[25]Mahadevan VS, Vondermuhll IF, Mullen MJ. Endovascular aortic coarctation stenting in adolescents and adults: angiographic and hemodynamic outcomes. Catheter Cardiovasc Interv. 2006 Feb;67(2):268-75.http://www.ncbi.nlm.nih.gov/pubmed/16400666?tool=bestpractice.com[26]National Institute for Health and Care Excellence. Balloon angioplasty with or without stenting for coarctation or recoarctation of the aorta in adults and children. July 2004 [internet publication].http://www.nice.org.uk/guidance/ipg74 在修复主动脉缩窄方面,经皮支架植入术的成功率为 98%。[27]Golden AB, Hellenbrand WE. Coarctation of the aorta: stenting in children and adults. Catheter Cardiovasc Interv. 2007 Feb 1;69(2):289-99.http://www.ncbi.nlm.nih.gov/pubmed/17191237?tool=bestpractice.com 有些研究者认为球囊血管成形术可能优于外科手术,[28]Wong D, Benson LN, Van Arsdell GS, et al. Balloon angioplasty is preferred to surgery for aortic coarctation. Cardiol Young. 2008 Feb;18(1):79-88.http://www.ncbi.nlm.nih.gov/pubmed/18205970?tool=bestpractice.com 但关于此种说法存在较大争议。经皮支架植入术可能优于单独使用球囊血管成形术,因为此种方法的再次狭窄发生率更低,且主动脉壁异常的发生率更低。[30]Pedra CA, Fontes VF, Esteves CA, et al. Stenting vs. balloon angioplasty for discrete unoperated coarctation of the aorta in adolescents and adults. Catheter Cardiovasc Interv. 2005 Apr;64(4):495-506.http://www.ncbi.nlm.nih.gov/pubmed/15789379?tool=bestpractice.com 支架植入术并发症的总发生率约为 12%,其中包括与股动脉穿刺相关的并发症、动脉瘤的形成、主动脉夹层和卒中。[27]Golden AB, Hellenbrand WE. Coarctation of the aorta: stenting in children and adults. Catheter Cardiovasc Interv. 2007 Feb 1;69(2):289-99.http://www.ncbi.nlm.nih.gov/pubmed/17191237?tool=bestpractice.com