Factors favoring stent-graft collapse after thoracic endovascular aortic repair

Canaud, Ludovic; Alric, Pierre; Desgranges, Pascal; Marzelle, J.; Marty-Ané, Charles; Becquemin, Jean‐Pierre

doi:10.1016/j.jtcvs.2009.06.017

Cited by 99 publications

(84 citation statements)

References 21 publications

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“…Les facteurs favorisant cet effondrement sont le surdimensionnement de l'endoproth ese et la mauvaise apposition dans une arche aortique fortement angul e. Le traitement de cette complication consiste la plupart du temps en une r eparation endovasculaire en ajoutant une prolongation proximale de l'endoproth ese. [23][24][25] Un autre probl eme li e au TEVAR est la couverture potentielle de l'ASCG. Un examen des publications de la litt erature montre principalement deux tendances.…”

Section: Discussionunclassified

Rupture traumatique aortique : 30 ans d’expérience

Malliet¹,

Houthoofd²,

Daenens³

et al. 2011

Annales de Chirurgie Vasculaire

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Section: Discussionunclassified

Rupture traumatique aortique : 30 ans d’expérience

Malliet¹,

Houthoofd²,

Daenens³

et al. 2011

Annales de Chirurgie Vasculaire

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“…The "bird beak configuration [9] [10] is a radiological finding of a wedge shaped gap between the undersurface of the SG and the aortic wall occurred in the SG at the lesser curvature of the ascending aorta was absent and no leakage was observed in the SG. Further, intimal hyperplasia was observed to occupy the majority of endoluminal SG.…”

Section: Case Reportmentioning

confidence: 99%

Angioscopic Observation of an Endoluminal Stent Graft: CT Imaging versus Angioscopic Imaging

Kobayashi¹,

Yamaguchi²,

Komatsu³

et al. 2016

WJCS

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We could observe the endoluminal stent graft (SG) following thoracic endovascular aneurysm repair (TEVAR) by a coronary artery angioscope and establish intravascular visualization of SG. The patient was a 70-year-old woman with the distal aortic arch aneurysm and the descending aortic aneurysm, and debranching TEVAR were performed. After 12 months follow up, urgent hospitalization was required for chest pain, and cardiac catheter examination with a coronary artery angioscope was performed. The endoluminal SG was observed. The observation in angioscope which is a video image is better than CT that is a still image, and observation in blood vessel or SG is possible. It may be possible to observe the endoluminal SG, allowing potential investigation of an endoleak, or the covering status of the SG with the native aortic vessel wall, or the state of intimal membrane formation in the endoluminal graft.

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“…This may ultimately induce to premature device failure and endograft collapse/ infolding, which usually requires a secondary intervention by means of re-do TEVAR or conversion to open surgery with attendant high morbidity and mortality [7][8][9][10]. The incidence rates of endograft collapse after TEVAR for traumatic injuries are not well defined [8,11], although collapses usually present in the early post-operative period (median time of 15 days) [12]. It has been recently reported that the Gore TAG thoracic endoprosthesis (W. L. Gore and Assoc, Flagstaff, Ariz) accumulated a 0.4% frequency rate of device collapse among 33,000 endografts distributed worldwide [6].…”

Section: Introductionmentioning

confidence: 99%

“…Endograft infolding-related mortality rates of 16.9% for asymptomatic patients and 27.3% for symptomatic patients within 3 years of diagnosis [11,13,14]. Collapses are most often observed when the proximal extent of the endograft is in the transverse arch with malapposition of the endograft wall along the lesser curvature of the aorta (the so-called "bird-beak" phenomenon) [9][10][11]14]. Bird-beaking is not desirable because it exposes the graft undersurface to the force of the bloodstream.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical implications of excessive endograft protrusion into the aortic arch after thoracic endovascular repair

Rinaudo

Raffa

Scardulla

et al. 2015

Computers in Biology and Medicine

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Endografts placed in the aorta for thoracic endovascular aortic repair (TEVAR) may determine malappositioning to the lesser curvature of the aortic wall, thus resulting in a devastating complication known as endograft collapse. This premature device failure commonly occurs in young individuals after TEVAR for traumatic aortic injuries as a result of applications outside the physical conditions for which the endograft was designed. In this study, an experimentally-calibrated fluid-structure interaction (FSI) model was developed to assess the hemodynamic and stress/strain distributions acting on the excessive protrusion extension (PE) of endografts deployed in four young patients underwent TEVAR. Endograft infolding was experimentally measured for different hemodynamic scenarios by perfusion testing and then used to numerically calibrate the mechanical behavior of endograft PE. Results evinced that the extent of endograft can severely alter the hemodynamic and structural loads exerted on the endograft PE. Specifically, PE determined a physiological aortic coarctation into the aortic arch characterized by a helical flow in the distal descending aorta. High device displacement and transmural pressure across the stent-graft wall were found for a PE longer than 21 mm. Finally, marked intramural stress and principal strain distributions on the protruded segment of the endograft wall may suggest failure due to material fatigue. These critical parameters may contribute to the endograft collapse observed clinically and can be used to design new devices more suitable for young individuals to be treated with an endoprosthesis for TEVAR of blunt traumatic aortic injuries.

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Factors favoring stent-graft collapse after thoracic endovascular aortic repair

Cited by 99 publications

References 21 publications

Rupture traumatique aortique : 30 ans d’expérience

Rupture traumatique aortique : 30 ans d’expérience

Angioscopic Observation of an Endoluminal Stent Graft: CT Imaging versus Angioscopic Imaging

Biomechanical implications of excessive endograft protrusion into the aortic arch after thoracic endovascular repair

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