Observations on the failure of stent-grafts in the aortic arch.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Endovascular Department, Malmö University Hospital, Malmö, Sweden. robhinchliffe@doctors.org.uk
R J
RJ
Hinchliffe
A
A
Krasznai
L
L
Schultzekool
J D
JD
Blankensteijn
M
M
Falkenberg
L
L
Lönn
K
K
Hausegger
M
M
de Blas
J M
JM
Egana
B
B
Sonesson
K
K
Ivancev
D000293:Adolescent; D000328:Adult; D017541:Aneurysm, False / Q000601:surgery; D000800:Angioplasty, Balloon; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery; D001019:Aortic Rupture / Q000601:surgery; D001807:Blood Vessel Prosthesis; D004937:Esophageal Fistula / Q000601:surgery; D005260:Female; D006083:Graft Occlusion, Vascular / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents