Thoracic aortic endograft explant: a single-center experience.
OBJECTIVE
We report our experience following thoracic aortic endovascular repair (TEVAR) explant.


METHODS
A total of 500 TEVARs were performed from 1999 to 2009, with 4 requiring explant. Chart review was performed to identify the indications of explant, operative technique, and perioperative morbidity and mortality.


RESULTS
Indications of graft removal included device maldeployment, type I endoleak, aortoenteric fistula, and retrograde type A dissection necessitating aortic root replacement. Reconstruction was achieved with aortic homograft, Dacron, or explant of the proximal component with incorporation of the distal stent into the suture line. Mean follow-up was 13 months (0-50 months). Paraplegia and perioperative death occurred in 1 patient who underwent intraoperative conversion to open repair. There were no other major complications, and graft removal was achieved in all patients.


CONCLUSIONS
Although rare, familiarity with TEVAR explant is imperative as it is increasingly performed for broader indications. Our limited data suggest that explant can be performed successfully albeit with morbidity.
Department of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. melissa.kirkwood@uphs.upenn.edu
Melissa L
ML
Kirkwood
Alberto
A
Pochettino
Ronald M
RM
Fairman
Benjamin M
BM
Jackson
Edward Y
EY
Woo
Grace J
GJ
Wang
D000368:Aged; D000784:Aortic Dissection / Q000209:etiology / Q000601:surgery; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000209:etiology / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D020878:Device Removal; D057867:Endoleak / Q000209:etiology / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015143:Philadelphia; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000209:etiology / Q000601:surgery