title: Infolding and collapse of thoracic endoprostheses: manifestations and treatment options.
abstract: OBJECTIVE
  We sought to review the clinical sequelae and imaging manifestations of thoracic aortic endograft collapses and infoldings and to evaluate minimally invasive methods of repairing such collapses.
  
  
  METHODS
  Two hundred twenty-one Gore endografts (Excluder, TAG; W. L. Gore & Associates, Inc, Flagstaff, Ariz) were deployed in 145 patients for treatment of pathologies including aneurysms and pseudoaneurysms, dissections, penetrating ulcers, transections, fistulae, mycotic aneurysms, and neoplastic invasions in 6 different prospective trials at a single institution from 1997 to 2007. Device collapses and infoldings were analyzed retrospectively, including review of anatomic parameters, pathologies treated, device sizing and selection, clinical sequelae, methods of repair, and outcome.
  
  
  RESULTS
  Six device collapses and infoldings were identified. Oversized devices placed into small-diameter aortas and imperfect proximal apposition to the lesser curvature were seen in all proximal collapses, affecting patients with transections and pseudoaneurysms. Infoldings in patients undergoing dissection represented incomplete initial expansion rather than delayed collapse. Delayed collapse occurred as many as 6 years after initial successful deployment, apparently as a result of changes in the aortic configuration from aneurysmal shrinkage. Clinical manifestations ranged from life-threatening ischemia to complete lack of symptoms. Collapses requiring therapy were remedied percutaneously by bare stenting or in one case by branch vessel embolization.
  
  
  CONCLUSIONS
  Use of oversized devices in small aortas carries a risk of device failure by collapse, which can occur immediately or after years of delay. When clinically indicated, percutaneous repair can be effectively performed.
authors.affiliation: Division of Interventional Radiology, Stanford University, Stanford, CA, USA. dansze@stanford.edu
authors.forename: Daniel Y
authors.initials: DY
authors.lastname: Sze
authors.forename: R Scott
authors.initials: RS
authors.lastname: Mitchell
authors.forename: D Craig
authors.initials: DC
authors.lastname: Miller
authors.forename: Dominik
authors.initials: D
authors.lastname: Fleischmann
authors.forename: Joan K
authors.initials: JK
authors.lastname: Frisoli
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Kee
authors.forename: Archana
authors.initials: A
authors.lastname: Verma
authors.forename: Michael P
authors.initials: MP
authors.lastname: Sheehan
authors.forename: Michael D
authors.initials: MD
authors.lastname: Dake
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery; D001013:Aorta, Thoracic / Q000293:injuries / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation; D006801:Humans; D008297:Male; D011138:Polytetrafluoroethylene; D011475:Prosthesis Failure; D015607:Stents; D055815:Young Adult
chemical_list: D011138:Polytetrafluoroethylene