Endovascular Covered Stent Repair of an Intercostal Artery Patch Dehiscence from a Descending Thoracic Aortic Aneurysm Graft

Abstract

Purpose: To describe the use of endovascular techniques to repair a descending thoracic aortic pseudoaneurysm at a site of patch dehiscence. Methods and Results: A 63-year-old hypertensive, diabetic female with a 4-cm aneurysm in the descending thoracic aorta underwent surgical repair with a 35-mm Dacron graft. Dehiscence of the intercostal arterial patch produced a large, 6-cm-diameter pseudoaneurysm that extended into the left thoracic cavity. An endovascular repair was planned using a Dacron stent-graft. Despite induced hypotension and an exteriorized, stiff exchange wire to enhance control of the delivery balloon catheter, the initial attempt failed to close the suture line defect. A customized polytetrafluoroethylene-covered, balloon-expandable stent was successfully deployed using the original stent-graft as a landmark. At 6 months, the contrast-enhanced spiral computed tomographic scan showed patency of the stent-graft and resorption of the pseudoaneurysm. Conclusions: This communication describes the management of a surgical complication using balloon-expandable covered stents in contrast to either conventional surgery or self-expanding stent-grafts. Transesophageal ultrasound monitoring delineated the suture line leak, identified the position of the stent-grafts, and accurately demonstrated closure of the defect.

Endovascular surgery for failed open aortic aneurysm repair*1

“…Less reported is the inversed sequence where endovascular repair is the procedure selected after failed open repair as reported here. With the search strategy applied to PubMed as reported above, two case reports came-up dealing with the endovascular repair of an intercostal patch dehiscence [16,17] as depicted schematically in Fig. 4E.…”

Interventional treatment of lateral tunnel dehiscence in a total cavopulmonary connection using a balloon expandable covered stent

“…They have also been used to occlude arteriovenous fistulae [4] and an aortopulmonary window [5]. Whereas covered stents have previously been used to complete Fontan procedures [6], and also to close aortic patch dehiscence [7], their use in the closure of an intracardiac dehiscence has not been described. The covered stent used was custom-made according to dimensions given to the manufacturers after preliminary angiographic assessment.…”