Observations on the Failure of Stent-grafts in the Aortic Arch

• DOI: 10.1016/j.ejvs.2007.06.005
• Publication Date: 2007-08-02T08:04:46Z
• Authors: R.J. Hinchliffe; A. Krasznai; L. SchultzeKool; J.D. Blankensteijn; M. Falkenberg; L. Lönn; K. Hausegger; M. de Blas; J.M. Egana; B. Sonesson; K. Ivancev
• Keywords: Thoracic aorta

The results of endovascular stent-grafts in the abdominal aorta and descending thoracic aorta have been encouraging. Expanding the use of thoracic stent-grafts in to the aortic arch has been associated with increasing numbers of complications. Recently isolated cases of stent-graft collapse have been reported.This was a multi-centre European case series. Data was collected retrospectively on seven patients from five experienced endovascular centres with thoracic stent-graft collapse.Of the seven patients four were treated for traumatic aortic rupture. Six were male, median age 33 (range 17-54) years. During the ensuing 2 months all patients suffered stent-graft collapse. This was symptomatic in 3 patients and the rest were identified on CT. Endovascular management was possible in 6/7 patients using either a balloon expandable stent (n=6) or further stent-graft (n=1). Two patients had persistent type I endoleak despite treatment. Two of the 7 patients died, both of which presented with symptomatic thoracic stent-graft occlusion. Both deaths were a direct result of stent-graft collapse.Thoracic stent-graft collapse may be asymptomatic underscoring the importance of stent-graft surveillance. Endovascular management of collapse is possible in most cases using a large balloon expandable stent. Symptomatic collapse is associated with high morbidity and mortality.