A multicenter experience of the management of collapsed thoracic endografts

Rami O. Tadros, Evan C. Lipsitz, Rabih A. Chaer, Peter L. Faries, Michael L. Marin, Jae Sung Cho

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Objectives: Thoracic endograft collapse after thoracic endovascular aortic repair (TEVAR) is a potentially devastating complication. This study evaluates the management of thoracic stent graft collapse. Methods: A multicenter review of thoracic stent graft collapse was performed from 2005 to 2009. Diagnosis and preoperative planning was performed by computed tomography angiography (CTA). Outcome measures included success of endovascular salvage, postoperative complications, and conversion to open repair. Results: Eleven patients (10 men) with thoracic endograft collapse were identified. Mean age was 41.2 years old (range, 21-66 years). Indications for the index TEVAR were traumatic aortic transections in 8 patients and acute type B dissections in 3 patients. All were initially treated with the TAG endoprosthesis (Gore and Associates, Flagstaff, Ariz). The median duration from initial repair to diagnosis of collapse was 9 days (range, 1 day-38 months). All collapses were initially treated by endovascular means using another TAG device in 7 patients, a Talent (Medtronic, Santa Rosa, Calif) thoracic stent graft in 3 patients, and a Palmaz (Cordis Endovascular, Warren, NJ) stent in 1 patient. In 1 patient, the secondary TAG did not resolve the collapse and required a Palmaz stent placement. Technical success rate was 91%, while re-expansion of the collapsed endograft was achieved in all patients. Early and late complications were observed in 3 patients. Delayed (>30 days) open conversion with device explantation was performed for an aortoesophageal fistula, physiological aortic coarctation, and prevention of a recurrent collapse in 1 patient each. There were no perioperative deaths or recurrent collapses. Conclusion: Endograft collapse can be successfully managed by endovascular techniques in most cases. Redo-TEVAR using high radial force devices should be considered the initial treatment of choice. Late endograft-related complications after treatment of collapsed endografts are not uncommon and can be safely managed by open conversion.

Original languageEnglish (US)
Pages (from-to)1217-1222
Number of pages6
JournalJournal of Vascular Surgery
Volume53
Issue number5
DOIs
StatePublished - May 2011

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Thorax
Stents
Transplants
Equipment and Supplies
Endovascular Procedures
Aptitude
Aortic Coarctation
Fistula
Dissection
Outcome Assessment (Health Care)
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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A multicenter experience of the management of collapsed thoracic endografts. / Tadros, Rami O.; Lipsitz, Evan C.; Chaer, Rabih A.; Faries, Peter L.; Marin, Michael L.; Cho, Jae Sung.

In: Journal of Vascular Surgery, Vol. 53, No. 5, 05.2011, p. 1217-1222.

Research output: Contribution to journalArticle

Tadros, Rami O. ; Lipsitz, Evan C. ; Chaer, Rabih A. ; Faries, Peter L. ; Marin, Michael L. ; Cho, Jae Sung. / A multicenter experience of the management of collapsed thoracic endografts. In: Journal of Vascular Surgery. 2011 ; Vol. 53, No. 5. pp. 1217-1222.
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