Ruptured aortic coarctation aneurysm: the culprit of the sudden death of Hyman and Zhu Gang A few years ago, Zhu Gang, an outstanding volleyball player in China, died suddenly on the court due to “ruptured coarctation aneurysm” and was immediately sent to Huaxi for overnight resuscitation, but could not come back to life. He died on the spot due to a ruptured clogged aneurysm. Thinking back to the famous American women’s volleyball player Hyman, who also died suddenly on the court due to a ruptured clotted aneurysm. A similar tragedy was repeated for more than 10 years. It is necessary to introduce the extremely dangerous disease of “clogged aneurysm”. Are all clogged aneurysms combined with hypertension? A high percentage of thoracic aortic coarctation aneurysms occur with hypertension. Many patients with an acute attack of coarctation have very high blood pressure. What are the usual clinical signs? If all three layers of the arterial wall burst during an attack, death occurs instantly. Usually the inner middle membrane breaks through the outer membrane to preserve it. Symptoms and typical clinic history. Sudden onset of hypertension, severe back pain and chest pain, profuse sweating, deficiency, and the first time as a heart attack, the disease should be considered when the electrocardiogram has no typical performance. CT findings of aortic cavity from one to two can be confirmed. Effective hypotension and cardiovascular surgery can be saved. The key is to control sudden hypertension and prevent the arterial wall from breaking through. How to treat clogged aneurysm? Treatment of thoracic aortic coarctation 1, surgery. Surgery is performed to open the chest and replace the arterial vessel of the clogged segment with an artificial vessel. There is a lot of trauma, bleeding, and complications. 2, Minimally invasive. Minimally invasive method, i.e., EVGE for intraluminal isolation of the entrapped aneurysm, is done by making a small incision in the thigh and guiding an artificial vessel along the femoral artery to the lesion to close the fissure. Why hypertension is dangerous in the case of entrapment – easy rupture. An entrapment is a dilated section of the aorta, often in the thoracic aorta as pictured, and an entrapment aneurysm is a large pulsating mass that looks like a tumor. The wall of the thoracic aorta, with three layers of outer-middle and inner membranes, is tightly connected without gaps, and it is critical that the middle membrane is thick and uniform. Hypertension causes damage to the inner and middle membranes, which are thin and easily broken. Then sudden blood pressure fluctuations, easy to break through the arterial wall to form a fissure, blood flow constantly wash, in the middle and outer membrane between the tear to form a sandwich. The greater the expansion of the outer layer, the more likely it is to rupture. Is endoluminal treatment suitable for all types of clogged aneurysms? Yes, most are. Closure can occur in all segments of the aorta. The ascending aorta and the clench are primarily treated with major open-heart surgery. The other segments can be treated basically with minimally invasive endoluminal therapy. Do they recur after minimally invasive treatment? How can it be prevented? Intraluminal isolated segment. This segment usually does not recur after success. Hypertension and atherosclerosis can recur if not controlled. Other segments. Most are occluded by thrombus, occasionally recurrence or multiple recurrences. Recurrence is uncommon. What should I pay attention to in my postoperative life? Most important: Take medication to control blood pressure and eliminate the primary disease. Other than this, you can live as normal. What follow-up medical treatment is required after endoluminal treatment? The main follow-up treatment is to control the primary factors of hypertension. This is the only way to achieve long-term results. Regular follow-up visits to check if the grafts are normal are mandatory 3-6-12 months after surgery and after one year as appropriate. Does endoluminal therapy require lifelong anticoagulation? EVGE generally does not require lifelong medication. Pseudoluminal thrombosis helps with closure. How much will EVGE cost? Currently, imported materials and stents are recommended, and the entire medical treatment costs about$100,000 to$100,000 or more. It is much less than in previous years. In contrast, the medical cost of artificial vessel replacement continues to rise. The cost of medical examination is higher. Are there any domestic stents? Our hospital has introduced imported and domestic stents Is there any conservative treatment for this disease? Strictly speaking, there is no conservative treatment. It is either untreated, which only lowers blood pressure to reduce the chance of rupture, or surgery, which is dangerous and damaging. Only interventional treatment is available, which is less dangerous and more effective.