title: Factors favoring stent-graft collapse after thoracic endovascular aortic repair.
abstract: 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 degrees-118 degrees ) were observed in all 4 patients. Oversizing over 20% was observed in 3 patients.
  
  
  CONCLUSIONS
  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.
authors: Department of Vascular and Thoracic Surgery, Arnaud de Villeneuve Hospital, Montpellier, France. ludoviccanaud@hotmail.com
authors: Ludovic
authors: L
authors: Canaud
authors: Pierre
authors: P
authors: Alric
authors: Pascal
authors: P
authors: Desgranges
authors: Jean
authors: J
authors: Marzelle
authors: Charles
authors: C
authors: Marty-Ané
authors: Jean-Pierre
authors: JP
authors: Becquemin
mesh_terms: D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D005602:France; D006801:Humans; D018579:Patient Selection; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome