Factors favoring stent-graft collapse after thoracic endovascular aortic repair.

OBJECTIVE Our objective was to assess potential causative factors of stent-graft collapse after thoracic endovascular aortic repair. METHODS We retrospectively reviewed clinical data and preoperative and postoperative computed tomographic scans of patients with thoracic stent-graft collapse in 2 French departments of vascular surgery. Aortic arch angulation, length of the lack of device wall apposition, proximal aortic diameter, and percentage of oversizing were assessed. RESULTS We report 4 cases of stent-graft collapse among 285 patients treated by thoracic endovascular aortic repair. All 4 patients were treated with the TAG stent graft. Only one of the patients had a symptomatic collapse: he was treated by stent-graft explantation and open repair. Endovascular management was performed in 3 of the 4 patients. None of the patients died. Lack of device wall apposition and acute aortic arch angle (range 92 degrees-118 degrees ) were observed in all 4 patients. Oversizing over 20% was observed in 3 patients. CONCLUSION This stent-graft-related complication seems related to poor apposition of the stent grafts in the highly angulated aortic arch. Excessive stent-graft oversizing could be an additional causative factor. Accurate assessment of aortic arch anatomic features, as well as the choice and sizing of the device, may prevent this complication.