Endovascular covered stent repair of an intercostal artery patch dehiscence from a descending thoracic aortic aneurysm graft.
OBJECTIVE
To describe the use of endovascular techniques to repair a descending thoracic aortic pseudoaneurysm at a site of patch dehiscence.


RESULTS
A 63-year-old hypertensive, diabetic female with a 4-cm aneurysm in the descending thoracic aorta underwent surgical repair with a 35-mm Dacron graft. Dehiscence of the intercostal arterial patch produced a large, 6-cm-diameter pseudoaneurysm that extended into the left thoracic cavity. An endovascular repair was planned using a Dacron stent-graft. Despite induced hypotension and an exteriorized, stiff exchange wire to enhance control of the delivery balloon catheter, the initial attempt failed to close the suture line defect. A customized polytetrafluoroethylene-covered, balloon-expandable stent was successfully deployed using the original stent-graft as a landmark. At 6 months, the contrast-enhanced spiral computed tomographic scan showed patency of the stent-graft and resorption of the pseudoaneurysm.


CONCLUSIONS
This communication describes the management of a surgical complication using balloon-expandable covered stents in contrast to either conventional surgery or self-expanding stent-grafts. Transesophageal ultrasound monitoring delineated the suture line leak, identified the position of the stent-grafts, and accurately demonstrated closure of the defect.
Dorros
G
G
William Dorros-Isadore Feuer Interventional Cardiovascular Disease Foundation Ltd., Milwaukee, Wisconsin 53215-3660, USA.
Avula
S
S
Fox
P
P
Rhomberg
B
B
Werner
P
P
D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D012086:Reoperation; D015607:Stents; D013529:Surgical Wound Dehiscence / Q000000981:diagnostic imaging / Q000601:surgery*
D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene