Endovascular repair of proximal endograft collapse after treatment for thoracic aortic disease

Abstract

We report two cases of proximal endograft collapse with an almost complete aortic occlusion after endovascular tube-graft treatment of thoracic aortic disease (thoracic aneurysm after a type B dissection, traumatic blunt aortic rupture) using the TAG Gore system. Oversizing of endografts is known to cause this complication. In our two cases, however, the oversizing was between 12% and 21.7%, which is less than the allowed oversizing of 25% that is recommended by the manufacturer. This endograft-related complication might be due to a poor alignment of the currently available endografts in highly angulated and tight aortic arches. In the first case, a combined endovascular and open emergent repair procedure achieved a reopening of the proximal endograft by proximal extension (TAG Gore). In the second case, proximal extension was not considered owing to a precise positioning of the endograft distal to the left carotid artery. A balloon-expanding Palmaz stent was therefore placed interventionally in the proximal part of the TAG graft to expand the endograft and to avoid another collapse of the device. This proximal endograft collapse has to be acknowledged as a potentially hazardous complication. We therefore recommend that the proximal part of thoracic endografts in the aortic arch should be closely monitored and we offer two possible endovascular solutions for resolving the problem of proximal endograft collapse.

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

“…Until such time that smaller endovascular aortic devices are commercially readily available, we propose that Cook ® Zenith ESLE iliac extension Stentgrafts can be used in the aorta, at least in patients who are deemed too high-risk for open operative repair. We agree with other vascular specialists [16] that small aortic endovascular devices should be developed for patients of small statures in emergency transaction, dissection, or mycotic rupture. [20] Funding: None.…”

“…[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.…”

Endograft collapse following endovascular repair of traumatic aortic injury

“…Currently available endografts are designed to treat atherosclerotic aneurysmal disease, and may be less suitable for the treatment of traumatic aortic injury due to both the need for excessive oversizing and limited conformability and longitudinal flexibility of the grafts. The three reported TAG collapsed endografts were oversized by 12%, 22% and 37% (11,12). Excessive oversizing, especially if by greater than 25%, may cause wrinkling of the graft and make it susceptible to collapse.…”

“…Two further cases of TAG endograft collapse have been reported, one occurring within 24 hours and the other presenting with chest pain at 2 months. These were also successfully repaired using TAG proximal extension and Palmaz stent respectively (12). No reports of this complication have been described in the literature with the use of the Zenith TX2 device.…”

Technical Challenges in Endovascular Repair of Complex Thoracic Aortic Aneurysms

“…The usefulness and low-invasiveness of TEVAR for thoracic descending aneurysms are apparent, but problems of TEVAR are concentrated in arch aneurysms 5,6) : placement in the curve and maintenance of branch blood flow. To deploy a stent graft in the arch, it is necessary to secure a landing zone as long as possible, for which we devised various methods.…”