Coral reef aorta

Last revised by Dr Daniel J Bell on 18 Aug 2021

Coral reef aorta (CRA) is a rare disease, described as hard calcifications involving the arterial wall which protrude into the lumen. It predominantly involves the posterior thoracic and abdominal aorta. Coral reef aorta luminal lesions can cause significant aortic stenosis.

Patients usually present at around 50 years of age, which is younger than most patients suffering from other arterial occlusive diseases. The frequency of coral reef aorta is estimated to be 6 in 1,000 (0.6%) 1.

Patients present with arterial occlusion-like symptoms such as intermittent claudication and visceral ischemia such as bowel involvement causing diarrhea, weight loss, and abdominal pain. Renovascular arterial hypertension symptoms are also common 1.

The pathophysiology of coral reef aorta is not well understood. It often occurs in patients that have traditional atherosclerotic risk factors: hypertriglyceridemia, hypercholesterolemia, tobacco smoking, diabetes, and hypertension 1. There may be a calcification regulation defect secondary to lack of serum fetuin-A (also known as alpha-2-Heremans-Schmid glycoprotein) which acts to inhibit ectopic calcification 1,3.

In coral reef aorta, non-contrast CT demonstrates dense, serpiginous, exophytic, calcifications of the aortic wall which protrude into the aortic lumen. This is in contrast to the typical appearance of atherosclerosis which follows the curve of the vessel wall. These lesions are located typically at the suprarenal and/or juxtarenal aorta causing significant occlusion. Lesions demonstrate a coral reef shape 2.

Recognition of the extensive endoluminal calcifications can have important implications for planning interventions and treatment, particularly for vascular surgeons and interventional radiologists 2.

Typically treatment for coral reef aorta is invasive surgery, most commonly thromboendarterectomy. Other techniques include aortoiliac and aortofemoral bypass. Relative postoperative complications include acute ischemia of the lower extremities and viscera such as the bowel 1.

The term coral reef aorta was coined in 1984 by Qvarfordt et al 1.

  • severe aortic atherosclerosis: differentiated from coral reef aorta by having calcific plaques involving the aortic wall without luminal projections 2

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Cases and figures

  • Case 1
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  • Case 2
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