Endovascular stent-graft repair of a complicated penetrating ulcer of the descending thoracic aorta: a word of caution.
OBJECTIVE
To report a pitfall encountered during stenting of a complicated penetrating ulcer of the descending thoracic aorta.


METHODS
A 65-year-old man was diagnosed with a complicated penetrating ulcer of the thoracic aorta. A 38-mm Talent endograft was implanted. On balloon dilation of the distal end of the endoprosthesis, the terminal bare stent became distorted and penetrated the aortic wall. A 42-mm endoprosthesis was immediately placed to exclude the aortic perforation. Control aortography demonstrated exclusion of the original proximal aortic ulcer and the distal iatrogenic aortic tear.


CONCLUSIONS
Endoprostheses may present some drawbacks in terms of elasticity and adaptability to tortuous and angulated diseased aortas. Caution is advised in the treatment of penetrating aortic ulcers where the aortic wall is diffusely friable. In this condition, balloon dilation should be limited to the covered portion of the stent-graft to prevent stent distortion and erosion through the aortic wall.
D'Ancona
Giuseppe
G
Department of Cardiovascular Surgery, Quebec Heart Institute, Sainte-Foy, Canada.
Bauset
Richard
R
Normand
Jean-Pierre
JP
Turcotte
Roc
R
Dagenais
François
F
D000368:Aged; D001013:Aorta, Thoracic / Q000293:injuries*; D001018:Aortic Diseases / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D004868:Equipment Failure; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D015607:Stents; D014456:Ulcer / Q000150:complications / Q000601:surgery*