Aortic arch rupture after multiple multilayer stent treatment of a thoracoabdominal aneurysm

Abstract

Despite the improvement in diagnostic and therapeutic strategies, the treatment of thoracoabdominal aneurysms is still burdened with a high incidence of peri/postoperative morbidity and mortality. The multilayer flow modulator is a new and promising technique for the treatment of such disease; however, some limits are still evident. We report the case of a 76-year-old woman affected by a symptomatic thoracoabdominal aneurysm treated with multiple Cardiatis multilayer flow modulators complicated by aortic arch rupture on the fifth postoperative day, with subsequent patient death.

Total Endovascular Repair of Thoracoabdominal Aortic Aneurysms With Non-Customized Stent Grafts

“…Persistent sac perfusion and subsequent aneurysm rupture have been reported by Lazaris and colleagues in 2012 [25]; stent rigidity leading to aortic rupture has been noticed by Ferrero and colleagues in 2013 [26]. Sultan and colleagues [27] recently released a result of 38 patients with TAAAs treated by off-label use of multilayer stents, in which an aneurysm-related mortality rate of 71.1% was documented.…”

Evidence of use of multilayer flow modulator stents in treatment of thoracoabdominal aortic aneurysms and dissections

“…There has been increasing clinical experience reported in the literature and a better understanding of its benefits and limitations. [24][25][26][27][28][29][30][31][32][33][34] Vaislic and colleagues reported the 3-year results of a prospective study on 23 patients treated by MFM stents for TAAAs. 28 Technical success was 100%, with no operative mortality or spinal cord injury.…”

“…Reinterventions in prior reports consisted of realignment of the MFM stent by stent grafts or by placement of additional MFM stents, with little evidence that these were effective. [24][25][26][27][28][29][30][31][32][33][34][35] Other endovascular alternatives (eg, F-BEVAR or parallel grafts) are not feasible to address rupture or branch-related problems, and therefore open surgical repair is the only definitive option. Until a welldesigned, prospective randomized trial with independent core laboratory monitoring is conducted, these questions and skepticism are likely to remain.…”

Multilayer Flow Modulator (MFM) Stent Insertion at Saccular Aneurysm in Peri-visceral Aorta: A Case Report.

“…With regards to involvement of the VA, to our knowledge this has been reported only in two other reports in the available literature 2,3 . In the presented case the proximal neck was sufficient to allow direct endograft placement within the SA.…”