92
Treatment
Table 37. Criteria for Significant CoA
The presence of significant CoA is based on evidence of upper extremity hypertension (at
rest, on ambulatory BP monitoring, or with pathologic blood pressure response to exercise)
or left ventricular hypertrophy and evidence for 1 of these gradient measurements:
1. A noninvasive blood pressure difference of >20 mm Hg between the upper and
lower extremities.
2. A peak-to-peak gradient of >20 mm Hg across the coarct by catheterization; or a
peak-to-peak gradient of >10 mm Hg across the coarct by catheterization in the
setting of decreased left ventricular systolic function or significant collateral flow.
3. A mean gradient of >20 mm Hg across the coarct by Doppler echocardiography;
or a mean gradient of >10 mm Hg across the coarct by Doppler echocardiography in
the setting of decreased left ventricular systolic function or significant collateral flow.
9.4.2.1. Aberrant Subclavian Artery, Kommerell's
Diverticulum
COR LOE
Recommendations
2a C-LD 1. In patients discovered to have an ASCA in the absence of
thoracic aortic imaging, dedicated imaging to assess for TAA is
reasonable.
2b C-LD 2. In patients with Kommerell's diverticulum, depending on
patient anatomy and comorbidities, repair may be reasonable
when the diverticulum orifice is >3.0 cm, the combined
diameter of the diverticulum and adjacent descending aorta is
>5.0 cm, or both (Figure 27).
9.4.2.2. Aberrant Left Vertebral Artery Origin
COR LOE
Recommendation
2a C-EO 1. In patients with an aberrant left vertebral artery origin arising
directly from the thoracic aorta who require aortic repair
involving reconstruction or coverage of the vertebral artery
origin, revascularization of the vertebral artery is reasonable.
