Factors favoring stent-graft collapse after thoracic endovascular aortic repair

Objective

Our objective was to assess potential causative factors of stent-graft collapse after thoracic endovascular aortic repair.

Methods

We retrospectively reviewed clinical data and preoperative and postoperative computed tomographic scans of patients with thoracic stent-graft collapse in 2 French departments of vascular surgery. Aortic arch angulation, length of the lack of device wall apposition, proximal aortic diameter, and percentage of oversizing were assessed.

Results

We report 4 cases of stent-graft collapse among 285 patients treated by thoracic endovascular aortic repair. All 4 patients were treated with the TAG stent graft. Only one of the patients had a symptomatic collapse: he was treated by stent-graft explantation and open repair. Endovascular management was performed in 3 of the 4 patients. None of the patients died. Lack of device wall apposition and acute aortic arch angle (range 92°–118°) were observed in all 4 patients. Oversizing over 20% was observed in 3 patients.

Conclusion

This stent-graft–related complication seems related to poor apposition of the stent grafts in the highly angulated aortic arch. Excessive stent-graft oversizing could be an additional causative factor. Accurate assessment of aortic arch anatomic features, as well as the choice and sizing of the device, may prevent this complication.

CTSNet classification: 26.1, 28

Abbreviations and Acronyms: CT, computed tomography, TEVAR, thoracic endovascular aortic repair