Endograft Collapse After Endovascular Treatment for Thoracic Aortic Disease

Abstract

Endovascular treatment is an established therapy for thoracic aortic disease. Collapse of the endograft is a potentially fatal complication. We reviewed 16 patients with a thoracic endograft between 2001 and 2006. Medical records of the treated patients were studied. Data collected include age, gender, diagnosis, indication for endoluminal treatment, type of endograft, and time of follow up. All patients (n = 16; mean age, 61 years; range, 21-82 years) underwent computed tomography (CT) for location of the lesion and planning of the intervention. Time of follow-up with CT scan ranged from 1 to 61 months. Indications for endovascular treatment were degenerative aneurysm (n = 7; 44%), aortic dissection (n = 2; 12%), perforated aortic ulcer (n = 4; 25%), and traumatic aortic injury (n = 3; 19%). Three patients suffered from a collapse of the endograft (one patient distal, two patients proximal) between 3 and 8 days after endovascular treatment. These patients were younger (mean age, 37 +/- 25 years vs. 67 +/- 16 years; P < 0.05) and showed more oversizing (proximal, 36 +/- 19.8% vs. 29 +/- 20.7% [P > 0.05]; distal, 45 +/- 23.5% vs. 38 +/- 21.7% [P > 0.05]). Proximal collapse was corrected by placing a bare stent. In conclusion, risk factors for stent-graft collapse are a small lumen of the aorta and a small radius of the aortic arch curvature (young patients), as well as oversizing, which is an important risk factor and is described for different types of endografts and protheses (Gore TAG and Cook Zenith). Dilatation of the collapsed stent-graft is not sufficient. Following therapy implantation of a second stent or surgery is necessary in patients with a proximal endograft collapse. Distal endograft collapse can possibly be treated conservatively under close follow-up.

Ten Years of Experience with the GORE EXCLUDER® Stent-Graft for the Treatment of Aortic and Iliac Aneurysms: Outcomes from a Single Center Study

“…Infolding of the endograft is a rare adverse event and typically seen in the proximal part of a thoracic endograft [23]. Analogous to thoracic stent-graft collapse, we recovered significant infolding in one patient by placing an additional PALMAZ Ò stent over the collapsed proximal part of the stent-graft.…”

First United States experience of the TX2 Pro-Form thoracic delivery system

“…[1][2][3] In the 2010 Gore TAG Annual Clinical Update (http://www.goremedical.com/resources/dam/ assets/AK0314EN5.TAG.MR.pdf), 136 instances of device compressions were reported in the setting of Ͼ33,500 device implants worldwide. This estimated incidence might be low due to under-reporting compared with single institutional experiences in which it was as high as 4%.…”

“…This malapposition can lead to endoleak and even complete graft collapse after TEVAR. [1][2][3] In this study, we report the first United States experience with the new TX2 Pro-Form (Cook Inc, Bloomington, Ind), a novel delivery system designed to enhance the apposition of the TX2 thoracic endograft to the arch, and compare the conformation achieved using this with two other thoracic endograft systems, the TX2 Z-Trak (Cook Inc) and the TAG (W.L. Gore and Assoc, Flagstaff, Ariz).…”

Successful emergency endovascular treatment of juxtarenal and infrarental mycotic aortic aneurysms in patients with small diameter aortae using Cook®Zenith ESLE Stentgrafts

“…[15][16][17][18][19] There are a few limitations to this paper. Using these Cook ® Zenith ESLE iliac extension limbs in these three patients appeared logical because of their small aortic diameters, but detailed follow-up information is still lacking in the literature.…”