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Case Reports
. 2011 May 24:6:76.
doi: 10.1186/1749-8090-6-76.

Delayed endovascular treatment of descending aorta stent graft collapse in a patient treated for post- traumatic aortic rupture: a case report

Giovanni Nano  1 , Daniela Mazzaccaro, Giovanni Malacrida, Maria Teresa Occhiuto, Silvia Stegher, Domenico G Tealdi
Affiliations
Case Reports

Delayed endovascular treatment of descending aorta stent graft collapse in a patient treated for post- traumatic aortic rupture: a case report

Giovanni Nano et al. J Cardiothorac Surg. .

Abstract

Background: We report a case of delayed endovascular correction of graft collapse occurred after emergent Thoracic Endovascular Aortic Repair (TEVAR) for traumatic aortic isthmus rupture.

Case presentation: In 7th post-operative day after emergent TEVAR for traumatic aortic isthmus rupture (Gore TAG® 28-150), a partial collapse of the endoprosthesis at the descending tract occurred, with no signs of visceral ischemia. Considering patient's clinical conditions, the graft collapse wasn't treated at that time. When general conditions allowed reintervention, the patient refused any new treatment, so he was discharged.Four months later the patient complained of severe gluteal and sural claudication, erectile disfunction and abdominal angina; endovascular correction was performed. At 18 months the graft was still patent.

Discussion and conclusion: Graft collapse after TEVAR is a rare event, which should be detected and treated as soon as possible. Delayed correction of this complication can be lethal due to the risk of visceral ischemia and limbs loss.

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Figures

Figure 1
Figure 1
Pre-operative CT scan. Preoperative CT-scan showing isthmus rupture with dissection of the thoracic aorta.
Figure 2
Figure 2
CT scan at 2nd postoperative day. The images show good apposition of the graft to the aortic wall, with no signs of endoleak.
Figure 3
Figure 3
CT scan before discharge. Partial collapse of the endoprosthesis at the descending tract.
Figure 4
Figure 4
Angiogram during reintervention. The angiogram demonstrates the increased collapse of the aortic graft with a sub-occlusion of its lumen.
Figure 5
Figure 5
Correction of the lesion. A Bolton Relay™ 28-155 graft located inside the previous one, with a bare-stent at the left subclavian artery, restores a single inner lumen and allows a continuous and valid blood flow to the descending aorta.
Figure 6
Figure 6
CT scan at 18 months. Regular diameter of the graft, normal renal perfusion, no signs of any endoleaks.
See this image and copyright information in PMC

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