Stent-graft collapse after endovascular treatment of aortic dissection — case report and review of literature

Abstract

Application of endovascular method for type B aortic dissection treatment is valuable option compared with open surgery. Despite the lower rate, complications in the endovascular treatment remain important issue. One of them is collapse of the prosthesis. The aim of the study was to present case of stent-graft collapse after endovascular treatment due to aortic dissection and management of this complication, and to highlight the weight of post-operative surveillance. A 44-year old male with resistant hypertension, treated due to aortic dissection 6 years ago, was admitted to Department of General, Vascular and Transplant Surgery of Warsaw Medical University, due to chest pain and decrease of claudication distance to 50 meters since last year. Computed tomography (CT) at admission revealed collapsed proximal part of Zenith stent-graft in descending aorta and fully patent false lumen of dissection. We performed endovascular treatment by additional Zenith stent-graft implantation, successfully restoring blood flow in the true lumen. In one-year observation patient remained asymptomatic and false lumen thrombosed. Stent-graft collapse is one of the rarest complications that occur after the endovascular treatment of the pathologies of thoracic aorta. Small radius of aorta, poor apposition to the inner curve of aorta and exceeding oversizing of the endograft were often reported as the etiology of the complication. Therefore strict CT surveillance is necessary due to wide spectrum of symptoms of collapsed prosthesis. Endovascular management with stent or stent-graft deployment should be first choice treatment.