A Stent-Graft Fracture After a 14-Year Thoracic Endovascular Aortic Repair
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LETTER TO THE EDITOR
ARTERIAL INTERVENTIONS
A Stent-Graft Fracture After a 14-Year Thoracic Endovascular Aortic Repair Wenhui Wu1 • Junzhou Pu1
Received: 8 May 2020 / Accepted: 4 July 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Dear Editor, Thoracic endovascular aortic repair (TEVAR) has been used widely for descending aortic pathologies over the last two decades. A growing number of TEVARs are followed by an increased incidence of late complications. The complication of stent-graft fracture has been described in prior literature [1]; however, the typical images—especially of late stent-graft fracture—are very limited. Recently, we detected a stent-graft fracture 14 years after a primary TEVAR. This complication was successfully managed through a hybrid approach. A 46-year-old man was admitted to our center for severe chest pain. The patient underwent TEVAR at another center 14 years before due to type B dissection. Last year, a routine computed tomography angiography (CTA) showed the thoracic aorta slightly dilated at the distal end of the stent-graft (Fig. 1A). The patient was recommended a control CTA in 12 months though he remained asymptomatic. During this time, the CTA revealed that the stentgraft fragmented completely from the third nitinol ring and the recurrence aortic dissection. Recurrent aortic dissection occurred along the anterolateral aspect of the stent-graft (Fig. 1B). We decided to perform a hybrid repair using the frozen elephant trunk (FET) technique combined with TEVAR because of an inadequate landing zone for a redo-TEVAR. Angiography demonstrated an obvious stent-graft fracture
& Junzhou Pu [email protected] 1
Interventional Department, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Beijing, China
and expanded thoracic aorta (Fig. 2A). First, we performed a left subclavian artery to carotid artery transposition. Then, our team initiated a cardiopulmonary bypass using the FET technique via a 24 * 150 mm stent-graft (Microport Medical, Shanghai, China). The following angiography showed an Ib endoleak at the end of FET (Fig. 2B). Afterwards, a 30 * 26 * 160 mm endovascular stent-graft (Microport Medical, Shanghai, China) was deployed overlapping the FET. The final angiography showed no endoleak (Fig. 2C). A follow-up CTA at 12 months showed adequate aortic remodeling and the diameter of the aorta regression (Fig. 1C). Stent-graft fracture is a disastrous complication of TEVAR. This complication may occur several years after the primary procedure [2]. However, a late stent-graft fracture occurred 14 years after TEVAR, which is rarely reported. Several possible mechanisms should be of concern. Stress fatigue is one of the postulates for metal fracture. Metal erosion has been detected in some stentgrafts that have been in place over a long period of time [3]. With the continuous improvement of materials and products, the current devices improve biocompatibili
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