Endovascular repair of proximal endograft collapse after treatment for thoracic aortic disease Markus G.M. Steinbauer, MD, Alexander Stehr, MD, Karin.

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Presentation transcript:

Endovascular repair of proximal endograft collapse after treatment for thoracic aortic disease Markus G.M. Steinbauer, MD, Alexander Stehr, MD, Karin Pfister, MD, Thomas Herold, MD, Niels Zorger, MD, Ingolf Töpel, MD, Christian Paetzel, MD, Piotr M. Kasprzak, MD Journal of Vascular Surgery Volume 43, Issue 3, Pages 609-612 (March 2006) DOI: 10.1016/j.jvs.2005.11.045 Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 1 Patient 1: a, Preinterventional MR-angiography of the thoracic aorta shows a type B dissection with a thoracic aneurysm (5.5 cm). b, Postprocedural computed tomography (CT) scan immediately after endograft placement with complete exclusion of the aneurysm/false lumen. c, CT scan of the chest 2 months after thoracic endografting. At the proximal end the endograft is collapsed and almost occludes the aorta, reperfusion of the dissection. d, Endovascular repair with overstenting of the proximal stent graft with another TAG endograft and carotid-subclavial bypass. e, Postinterventional CT-scan after ballooning of hemodynamic relevant stenosis at overlapping area of endografts showing an improve alignment and good attachment of the new endograft to the small curvature of the aortic arch. Journal of Vascular Surgery 2006 43, 609-612DOI: (10.1016/j.jvs.2005.11.045) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 2 Patient 2: a and b, Post-traumatic computed tomography (CT) scan of a 24-year-old woman after a motorcycle accident reveals a blunt thoracic aortic rupture distal to the left subclavian artery. c, Postinterventional CT scan with a correct position of the stent distal to the left carotid artery. The reconstruction of the CT scan revealed a significant lack of attachment of the proximal stent in the small curvature of the aortic arch, which was interpreted as a potentially dangerous proximal stent instability. d and e, CT scan before the repair procedure (24 hours after the postinterventional CT scan): collapse of the proximal stent with almost complete occlusion of the aortic lumen and reperfusion and growth of the traumatic aneurysm. f, repair procedure: angiogram of the aortic arch with collapsed endograft and reperfusion of the false aneurysm. g, Postinterventional CT scan after insertion and ballooning of a 14- to 25-mm-diameter × 30.58- to 37.79-mm-long Palmaz stent fixed on a Maxi LD 22/40 balloon within the proximal part of the endograft. The Palmaz stent has reopened and fixed proximal endograft; furthermore, it corrected the radius of the arch and flattened the curve, thus compressing the endograft towards the inner curve of the arch. This resulted in an exclusion of the traumatic aneurysm. Journal of Vascular Surgery 2006 43, 609-612DOI: (10.1016/j.jvs.2005.11.045) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions