Anatomic factors associated with acute endograft collapse after Gore TAG treatment of thoracic aortic dissection or traumatic rupture

Abstract

Thoracic endograft collapse is an exceedingly rare event. In this series, endoprosthesis collapse occurred in patients who were treated outside the manufacturer's instructions for use for minimum required aortic diameter. Although distal aortic diameter and minimum intragraft aortic diameter predicted collapse, other variables may also influence this complication but were not significant owing to potential type II statistical errors. In the future, caution should be exercised when contemplating TEVAR in patients with small (<23 mm) aortic diameters.

Endovascular Management of Thoracic Dissections

“…In a separate series, 6 cases of stent-graft collapse were reported after treatment of 5 traumatic aortic injuries and 1 dissection with the TAG device. 89 Both reports attributed all cases to oversizing of the stent graft to the aorta. These cases may reflect the inherent difficulty of sizing stent grafts in patients with extremely small true lumens.…”

Editor's Choice – Management of Descending Thoracic Aorta Diseases

“…This anatomical variant may limit the optimal apposition of the stent graft to the inner aortic curvature, leading to "bird beaking" and an increased risk of endoleak and stent collapse. 163 The average diameter of the thoracic aorta, proximal and distal to the rupture site, is 19 mm in patients with trauma. Excessive oversizing (>20%) has been associated with an increased risk of device collapse.…”

“…Excessive oversizing (>20%) has been associated with an increased risk of device collapse. 163 With respect to preoperative CTA measurements, stent grafts should be oversized by about 10%. More aggressive oversizing may be applied in gravely hypotensive patients, but not exceeding 20%.…”

Own Clinical Observations of Treatment Outcome in Acute Type B Aortic Dissection

“…The primary aim of endovascular surgery is to close proximal and distal portals of entry (entries and re-entries) of the dissection, and to restore proper blood flow in the true channel (22).…”