Incidence and outcomes after infolding or collapse of thoracic stent grafts

Abstract

TAG device infolding appears to be an infrequent event, primarily occurring in young trauma patients secondary to excessive oversizing and severe proximal aortic angulation. However, there clearly exists a need for devices that treat such patients. As a result, future device designs should consider the compression failure mode when being designed in order to help prevent such events.

Editor's Choice – Management of Descending Thoracic Aorta Diseases

“…299 TEVAR may result in stent graft related complications such as endoleak, stent graft migration, or stent graft collapse. 106,107 The primary importance of the surveillance protocols is to prevent these complications.…”

“…Other complications (device or procedure related) can include aortic rupture during deployment, angulation, migration, or collapse of the stent graft, false aneurysm formation at the proximal or distal end of the stent graft, graft erosion, or stent frame fracture. 106 A retrograde type A dissection is associated with devastating outcomes. TEVAR for aortic dissection is particularly prone to retrograde type A aortic dissection.…”

Upside down use of Gore Excluder or Cook Zenith Legs

“…Oversizing can potentially result in infolding or wrinkling of the device and under sizing can definitely lead to endoleaks [4] even after balloon touch-up. In addition, size discrepancies can lead to distal ischemia caused by stenosis or occlusion of the device lumen [5].…”

Biomechanical implications of excessive endograft protrusion into the aortic arch after thoracic endovascular repair

“…TEVAR for traumatic injuries is effective but its outcome remains a concern especially in young patients [4,5]. In these individuals, the endograft is often implanted "off-label", and device oversizing is essential for fixation at the level of the proximal landing zone [6]. This may ultimately induce to premature device failure and endograft collapse/ infolding, which usually requires a secondary intervention by means of re-do TEVAR or conversion to open surgery with attendant high morbidity and mortality [7][8][9][10].…”

“…The incidence rates of endograft collapse after TEVAR for traumatic injuries are not well defined [8,11], although collapses usually present in the early post-operative period (median time of 15 days) [12]. It has been recently reported that the Gore TAG thoracic endoprosthesis (W. L. Gore and Assoc, Flagstaff, Ariz) accumulated a 0.4% frequency rate of device collapse among 33,000 endografts distributed worldwide [6]. However, collapse rates likely differ for other available endografts.…”