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Case Reports
. 2022 Aug 7;8(4):646-650.
doi: 10.1016/j.jvscit.2022.07.013. eCollection 2022 Dec.

Crushing of a bridging stent during follow-up of endovascular branched aortic arch repair: A novel mode of failure

Martijn L Dijkstra  1   2 , Angelos Karelis  1 , Björn Sonesson  1 , Roberta Vaccarino  1 , Nuno V Dias  1
Affiliations
Case Reports

Crushing of a bridging stent during follow-up of endovascular branched aortic arch repair: A novel mode of failure

Martijn L Dijkstra et al. J Vasc Surg Cases Innov Tech. .

Abstract

A 68-year-old man developed aneurysmal degeneration of the aortic arch and proximal descending aorta after an open ascending graft for a type A aortic dissection. A three-branched endovascular aortic arch repair was performed with patency of all branches despite some degree of initial misalignment of the branches in relation to the target vessels. At 6 months postoperatively, an asymptomatic partial crushing of the left common carotid bridging grafts was observed on computed tomography angiography. This was treated by reinforcing the branch with a balloon-expandable endograft. The postoperative course was uneventful but a computed tomography angiography after 1 month showed recurrent asymptomatic compression. A left carotid-subclavian bypass was eventually performed. We have reported a new failure mode of an inner branch arch repair of residual type A chronic dissection.

Keywords: Aortic arch repair; Endograft; Inner branch.

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Figures

Fig 1
Fig 1
Preoperative computed tomography angiography (CTA) showing multiplanar reconstruction images (A, B) of the arch plus proximal descending aortic aneurysm and selective completion angiogram from the initial procedure showing the successful implantation of an arch stent graft with patent target vessels (C).
Fig 2
Fig 2
Fluoroscopy image with fusion markers, showing the misalignment of left common carotid (LCC) artery and its respective inner branch with diamond form (dashed red line).
Fig 3
Fig 3
Postoperative computed tomography angiography (CTA) at 1 and 6 months showing kinking and crushing of the left common carotid (LCC) bridging endograft with significant narrowing of the lumen: (A,B) 1 month, (C,D) 6 months.
Fig 4
Fig 4
Postoperative computed tomography angiography (CTA) at 1 month after secondary procedure showing new compression of left common carotid (LCC) branch.
Fig 5
Fig 5
Postoperative three-dimensional reconstruction at 32 months showing an excluded aneurysm with patent true lumen, two branches and left carotid-subclavian bypass.
See this image and copyright information in PMC

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