Endovascular repair of traumatic thoracic aortic disruptions with “stacked” abdominal endograft extension cuffs

Abstract

Stent-graft repair of TTAD is technically feasible. The technique of "stacked" aortic cuffs provides an acceptable option when urgent therapy is needed, when patients are deemed high-risk for open operative repair, or until thoracic endografts are designed which can safely treat focal, smaller aortic diameter injuries.

Iliac Leg and Abdominal Aortic Cuff Stent-Graft for Blunt Thoracic Aortic Injury in Young Patient

“…2,11) However, there remain some challenges among young patients with smaller aorta and access vessel, and more severe angulated aortic arch. These factors may lead to difficulty in finding appropriate stent-graft size, higher risk of migration, endoleak, device fracture and collapse, or iliac artery avulsions.…”

“…12) In young patients, the smallest available thoracic endograft (diameter of 22 mm) would not be greatly oversized, but would not secure the suitable apposition for severely angulated aortic arch and could potentially have higher complication rate. 5,11) Sequential stacked placement of abdominal cuffs endograft (smallest available diameter of 23 mm, for emergency cases in Japan) can resolve such anatomical problems. Even though the use of abdominal cuffs endograft to treat BTAI is "off label", no enfolding or device collapse has been reported with this technique and result in only 13% of complication rates.…”

Successful emergency endovascular treatment of juxtarenal and infrarental mycotic aortic aneurysms in patients with small diameter aortae using Cook®Zenith ESLE Stentgrafts

“…Patients with these small infrarenal aortic diameters create new challenges in endovascular treatment, especially if custom-made aortic stentgrafts are not immediately available. [8] The smallest stentgraft diameter for the commercialized Cook ® Zenith TX2 thoracic endovascular graft and Cook ® Zenith AAA endovascular Graft is 22 mm, with the minimal length of 115 mm. The smallest aortic stentgraft diameter for the commercialized Medtronic Valiant ® thoracic endovascular graft is also 22 mm, with the minimal length of 107 mm.…”

“…The thoracic Gore-TAG endograft has a minimal diameter of 26 mm. [8] These commercialized stentgrafts may excessively oversized compared to the narrow native aorta, and may cause infolding, kinking, or collapse, thus preventing adequate seal.…”

“…[11] Various types of "stacked" abdominal endograft extension cuffs have also been reported. [8] The use of the Cook Zenith proximal abdominal aortic (ESBE) cuffs with similar diameters to the ELSE iliac extenders may be an alternative.…”