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An aneurysm originating from Abbott’s Artery in coarctation of the aorta: a case report

Published online by Cambridge University Press:  10 February 2025

Yuting Xia ,
Bo Wang  and
Qi An Open the ORCID record for Qi An [Opens in a new window]
Yuting Xia
Affiliation:
Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
Bo Wang
Affiliation:
Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
Qi An*
Affiliation:
Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
*
Corresponding author: Qi An; Email: anqi@scu.edu.cn
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Abstract

Coarctation of the aorta is a rare congenital cardiovascular anomaly. In some patients, one particular vessel in collateral circulation has achieved recognition as the artery of Hamilton and Abbott. This aberrant pathway can create local turbulence, elevating the risk of aneurysm formation. We report the clinical treatment of a 35-year-old patient with coarctation of the aorta combined with an aneurysm originating from the artery of Hamilton and Abbott to highlight the need for attention to the presence of this artery.

Keywords

Coarctation of the aortaAbbott’s ArteryaneurysmCHDendovascular treatment

Information

Type
Brief Report
Information
Cardiology in the Young , Volume 35 , Issue 3 , March 2025 , pp. 613 - 615
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Copyright
© The Author(s), 2025. Published by Cambridge University Press

Introduction

Coarctation of the aorta is a rare CHD, and long-term haemodynamic changes of it can lead to complications such as left heart failure. If untreated, the persistence of the coarctation leads to the gradual development of collateral circulation. One particular vessel in this collateral circulation has achieved recognition as the artery of Hamilton and Abbott. This artery was first documented in 1928 by Hamilton and Abbott, who reported the presence of an anomalous artery originating from the descending aortic arch approximately 1 cm above the insertion site of the obliterated duct arteriosus in a case of complete obliteration of the descending aortic arch at the insertion of the duct in a 14-year-old boy. Reference Hamilton and Abbott1 Schuster and Gross subsequently noted in their publication ‘‘SURGERY FOR COARCTATION OF THE AORTA: A Review of 500 Cases’’ that this artery was termed ‘‘Abbott’s Artery.’’ They observed that this artery is absent in normal subjects and not documented in standard anatomy textbooks. Its diameter can vary from a few millimetres to nearly one centimetre. Origins of this artery may include the posterior wall of the aortic arch or the posterior aspect of the subclavian artery. They also illustrated potential origins of this artery in patients with aortic coarctation. Furthermore, they underscored the critical importance of identifying such collateral vessels to prevent intraoperative catastrophic bleeding. Reference Schuster and Gross2

It is well known that the narrow site-induced turbulent blood flow can increase the risk of aneurysm formation and the presence of an aneurysm will complicate the treatment. An aneurysm may occur in the pre- and post-coarctation aortic segments and in the collateral arteries, including the artery of Hamilton and Abbott. Reference Arıkan, Omay and Talas3 There are few reports on the artery of Hamilton and Abbott in coarctation of the aorta. Here, we report the successful treatment of aortic coarctation with an aneurysm originating from the artery of Hamilton and Abbott using endovascular intervention. Reference Schuster and Gross2

Case presentation

A 35-year-old male was initially diagnosed with hypertension 10 years ago at a clinic after presenting with recurrent headaches and was prescribed oral metoprolol tartrate. He returned one month ago due to poorly controlled blood pressure, with readings as high as 230 mmHg. A recent chest-enhanced CT scan revealed significant aortic narrowing, prompting his referral to our hospital for further treatment. Pre-operative CT angiography and 3D reconstruction demonstrated coarctation of the aorta with extensive collateral formation. Notably, an aneurysm was observed on the descending aorta, and the other end of it is connected to the subclavian artery (Figure 1A). After careful evaluation, we decided to proceed with endovascular intervention. Under general anaesthesia, a temporary pacing lead was placed in the right heart via the femoral vein. A 5F Vertebral (VER) catheter and guidewire were used to successfully cross the coarctation site, with angiography confirming its precise location (Figure 1B). A 12F Cook sheath was advanced across the coarctation, and a Cheatham Platunum (CP) stent mounted on a Balloon in Balloon (BIB) was deployed at the coarctation site under rapid pacing at 180 bpm. Post-deployment angiography confirmed satisfactory stent placement and relief of the coarctation (Figure 1C). Next, we addressed the aneurysm of the Abbott’s Artery. Using a 6F Multipurpose Dilator (MPD) catheter, along with a micro-guidewire and microcatheter, we navigated into the aneurysm. Angiography confirmed the presence of the aneurysm and allowed us to accurately measure its diameter (Figure 2A). The microcatheter was then advanced into the upstream vessel of the aneurysm for selective angiography, which revealing its connection to the left subclavian artery. A microcoil was used to embolise the upstream vessel, followed by the deployment of 14–20 mm microcoils to fill the aneurysm. However, the aneurysm and the opening to the descending aorta remained, allowing blood to reflux into the aneurysm sac, potentially enlarging it. Therefore, we used an Amplatzer Vascular Plug (AVP) II to occlude the opening (Figure 2B). Subsequent angiography confirmed the absence of blood flow within the aneurysm sac. The guidewires and catheters were then removed, and the puncture sites were compressed and bandaged. The patient had an uneventful post-operative recovery. Follow-up CT showed no residual coarctation, and the aneurysm was successfully occluded (Figure 2C). During the last follow-up, the patient’s systolic pressure had significantly decreased to 160 mmHg, and he reported no discomfort.

Figure 1.

(a) Pre-operative CT angiography and 3D reconstruction demonstrated coarctation of the aorta with aneurysm; (b) angiography confirmed narrow site; and (c) post-deployment angiography confirmed satisfactory stent placement and relief of the coarctation. LSA = left subclavian artery; CoA = coarctation of the aorta; DAo = descending aorta; AA = aortic aneurysm.

Figure 2.

(a) Angiography confirmed the presence of the aneurysm; (b) using an Amplatzer Vascular Plug II to occlude the opening; and (c) follow-up CT showed no residual coarctation, and the aneurysm was successfully occluded.

Discussion

In 1928, Hamilton and Abbott described the presence of an anomalous artery from the descending arch about 1 cm above the insertion of the obliterated duct in the case of complete obliteration of the descending arch at insertion of the duct in a boy of 14 years of age. Reference Hamilton and Abbott1 Subsequently, Schuster and Gross introduced term ‘‘Abbott’s Artery’’ to describe this blood vessel encountered during aortic coarctation surgery and emphasised its significance as an anatomical marker, because of the high risk of severe intraoperative bleeding if damaged. Reference Schuster and Gross2 In his article of Abbott’s Artery, Leberg observed that many of the origins described by Schuster and Gross differed from Hamilton and Abbott’s original findings. Reference Lerberg4 This is indeed the case; therefore, we believe what is actually referred to “Abbott’s Artery” should be called the collateral artery of Hamilton and Abbott, which bypasses the contractile lesion. The term is intended to alert surgeons to potential vascular abnormalities associated with this congenital disorder and improve the safety of surgery. In addition, the presence of the artery of Hamilton and Abbott can alter the haemodynamic characteristics of coarctation of the aorta patients. Typically connecting to the left subclavian artery or the posterior wall of the aortic arch, this abnormal blood flow pathway can induce local turbulence, further increasing the haemodynamic burden at the coarctation site and elevating the risk of aneurysm formation. Aneurysms complicate coarctation of the aorta by increasing the risk of rupture and associated high mortality. Stent implantation for aortic coarctation is now the first treatment option in adults and children (> 15 kg). Reference Stout, Daniels and Aboulhosn5 However, current guidelines do not adequately address the treatment of associated aneurysms. In this case, we used an AVP combined with microcoils to treat the aneurysm. Microcoil embolisation is known to be effective for small-neck aneurysms, but large aneurysms may require numerous coils, making it costly. The AVP has been shown to be an suitable alternative to coil embolisation, and it take significantly less time to perform and required decreased fluoroscopy times. Reference Ryer, Garvin, Webb, Franklin and Elmore6 Thus, combining AVP with microcoils is a better choice. Although AVP was initially used for CHD closures, its precise placement, low risk of migration, and minimal complications have made it advantageous for preventing and treating vascular diseases.

Conclusion

The artery of Hamilton and Abbott represents a type of collateral circulation in aortic coarctation. Its presence can contribute to aneurysm formation, significantly increasing the risk of rupture and haemorrhage, which has critical implications for surgical procedures. Therefore, it is essential to recognise the existence of this artery and address it proactively.

Data availability statement

The corresponding author will share the data underlying this article at a reasonable request.

Author contributions

Yuting Xia: Conceptualisation; Project administration; Writing—original draft.

Bo Wang: Visualisation; Writing—original draft.

Qi An: Project administration; Supervision; Writing—review & editing.

Financial support

This study was funded by Sichuan Science and Technology Program (2023YFS0303).

Competing interests

None.

Disclosure statement

None.

Informed consent statement

Consent was obtained from the patient’s family.

References

Hamilton, WF, Abbott, ME. Coarctation of the aorta of the adult type. Am Heart J 1928; 3: 381–421.10.1016/S0002-8703(28)90385-3CrossRefGoogle Scholar
Schuster, SR, Gross, RE. Surgery for coarctation of the aorta. A review of 500 cases. J Thorac Cardiovasc Surg 1962; 43: 54–70.10.1016/S0022-5223(20)31628-7CrossRefGoogle ScholarPubMed
Arıkan, AA, Omay, O, Talas, Z, et al. Coarctation of the aorta with aortic and subclavian artery aneurysms. J Card Surg 2021; 36: 2171–2174. doi: 10.1111/jocs.15491.CrossRefGoogle ScholarPubMed
Lerberg, DB. Abbott’s artery. Ann Thorac Surg 1982; 33: 415–416. doi: 10.1016/s0003-4975(10)63242-0.CrossRefGoogle ScholarPubMed
Stout, KK, Daniels, CJ, Aboulhosn, JA, et al. AHA/ACC guideline for the management of adults with congenital heart disease: a report of the American college of cardiology/American heart association task force on clinical practice guidelines. J Am Coll Cardiol 2018; 73: e81–e192. doi: 10.1016/j.jacc.2018.08.1029.CrossRefGoogle Scholar
Ryer, EJ, Garvin, RP, Webb, TP, Franklin, DP, Elmore, JR. Comparison of outcomes with coils versus vascular plug embolization of the internal iliac artery for endovascular aortoiliac aneurysm repair. J Vasc Surg 2012; 56: 1239–1245. doi: 10.1016/j.jvs.2012.05.001.CrossRefGoogle ScholarPubMed
Figure 0

Figure 1. (a) Pre-operative CT angiography and 3D reconstruction demonstrated coarctation of the aorta with aneurysm; (b) angiography confirmed narrow site; and (c) post-deployment angiography confirmed satisfactory stent placement and relief of the coarctation. LSA = left subclavian artery; CoA = coarctation of the aorta; DAo = descending aorta; AA = aortic aneurysm.

Figure 1

Figure 2. (a) Angiography confirmed the presence of the aneurysm; (b) using an Amplatzer Vascular Plug II to occlude the opening; and (c) follow-up CT showed no residual coarctation, and the aneurysm was successfully occluded.