Fenestrated Aortic Arch Stent-Graft Malfunction With Endovascular Salvage

Abstract

This is a rare but cautionary example of the potential pitfalls of translating endograft technology from the abdominal aorta to the hostile environment of the aortic arch. It is likely that a combination of the arch curvature and hemodynamic forces, combined with the narrowed true lumen, contributed to failure of the trigger-wire tie release mechanism. Consideration of these endovascular salvage maneuvers may benefit interventional specialists who treat such diseases of the aortic arch.

TEVAR and its implications on arch vessels

“…One case report was excluded because it describes the malfunction of the deployment system of a stentgraft. 22 One cohort described a valve sparing aortic root replacement and the other cohort study described the use of scalloped stentgraft for several vessels (LSA and visceral); however, the individual results for the LSA scalloped stentgraft could not be extracted from the article. 23,24 Manual cross search of all reference lists yielded no additional articles.…”

“…For this latter problem, the in situ laser fenestration offers a solution, however, early results show endoleaks and fabric problems rendering, the presently available endograft not ready for clinical application. 21,22 A new fully endovascular alternative is the scalloped stentgraft. Described mostly in small case series or reports it shows promising early results with low endoleak and stroke rates.…”

Early experience and technical aspects of physician-modified fenestration in thoracic endovascular aortic repair for aortic arch pathologies

“…Additionally, deployment of custom-made grafts is associated with some problems. 14 The chimney technique is a relatively simple and “on-the-shelf” method for revascularization of aortic arch branches. However, because of the complications of endoleakage and migration, the chimney technique (especially the double chimney technique) should be used judiciously.…”

Results From a Nationwide Registry on Scalloped Thoracic Stent-Grafts for Short Landing Zones

“…Besides 5 case reports 17,22-25 describing this technique in 1 to 4 patients, only 2 other case series using a scalloped thoracic stent-graft have been published to date. 26,27 A 10-patient series with the proximal scallop targeting the LSA, LCCA, or innominate artery reported 10% 30-day mortality, with 1 postoperative ischemic stroke and 1 type Ib endoleak.…”