Division of Vascular Surgery, Mount Sinai Medical Center, New York, NY, USA.
J Vasc Surg. 2011 May;53(5):1217-22. doi: 10.1016/j.jvs.2010.10.119. Epub 2011 Jan 17.
Thoracic endograft collapse after thoracic endovascular aortic repair (TEVAR) is a potentially devastating complication. This study evaluates the management of thoracic stent graft collapse.
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.
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.
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.
胸主动脉腔内修复术（TEVAR）后胸主动脉内移植物塌陷是一种潜在的破坏性并发症。本研究评估了胸主动脉移植物塌陷的处理方法。
对 2005 年至 2009 年期间发生的胸主动脉移植物塌陷的多中心病例进行回顾性分析。通过计算机断层血管造影术（CTA）进行诊断和术前规划。观察指标包括血管内修复的成功率、术后并发症和转为开放修复的情况。
共确定 11 例（10 例男性）胸主动脉移植物塌陷患者。平均年龄为 41.2 岁（范围 21-66 岁）。8 例患者的初始 TEVAR 适应证为外伤性主动脉横断，3 例患者为急性 B 型夹层。所有患者最初均使用 TAG 支架（戈尔和协会，亚利桑那州弗拉格斯塔夫）治疗。从初始修复到诊断塌陷的中位时间为 9 天（范围 1 天-38 个月）。7 例患者最初通过血管内方法使用另一个 TAG 装置、3 例患者使用 Talent（美敦力，加利福尼亚州圣罗莎）胸主动脉支架和 1 例患者使用 Palmaz（柯迪斯血管内，新泽西州沃伦）支架来治疗所有塌陷。在 1 例患者中，第二次使用 TAG 并未能解决塌陷问题，需要放置 Palmaz 支架。技术成功率为 91%，所有患者的塌陷移植物均成功扩张。3 例患者出现早期和晚期并发症。为了治疗 1 例患者的主动脉食管瘘、生理性主动脉缩窄和预防再次塌陷，分别在术后 30 天后进行了延迟（>30 天）的开放转换和器械取出。无围手术期死亡或再次塌陷。
在大多数情况下，血管内技术可以成功治疗移植物塌陷。在初次治疗中，应考虑使用高径向力装置进行再次 TEVAR。治疗塌陷移植物后，移植物相关的晚期并发症并不少见，但可以通过开放转换安全处理。
