title: Challenging endovascular repair of a critical aortic endograft migration and massive type III endoleak.
abstract: Type III endoleaks, which may be caused by endograft disconnection, pose the risk of aneurysm enlargement and rupture because the pressure in the aneurysmatic sac tends to equal the systolic aortic pressure. We report the endovascular treatment of a critical dislocation of two thoracic aorta endografts with subsequent massive aneurysmatic pressurization of the aneurysmatic sac, which led to its impending rupture. The aberrant migration of both endografts required a combined, right humeral and left femoral, approach to capture the guide wire with an endovascular snare in the aneurismal sac. Several maneuvers were necessary to avoid trapping the guide wire in one of the bare stents. A final 'push-pull' technique was used to loop the wire and advance the new endografts into the ascending aorta to achieve a correct exclusion of the endoleaks. The patient suffered a perioperative stroke which could have been a complication of wire manipulation in the highly atheromatous aortic arch. A review of several maneuvers which may be taken to prevent these complications has been performed.
authors.affiliation: Department of Cardiovascular Surgery, Complejo Hospitalario Universitario A Coruña, As Xubias 84, CP 15006, A Coruña, Spain. vxmr@yahoo.es
authors.forename: Victor X
authors.initials: VX
authors.lastname: Mosquera
authors.forename: Milagros
authors.initials: M
authors.lastname: Marini
authors.forename: Ignacio
authors.initials: I
authors.lastname: Cao
authors.forename: Jose J
authors.initials: JJ
authors.lastname: Cuenca
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D011475:Prosthesis Failure; D012086:Reoperation; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome