Anatomic factors associated with acute endograft collapse after Gore TAG treatment of thoracic aortic dissection or traumatic rupture
Received 7 October 2006; accepted 11 December 2006. published online 20 February 2007.
Objective
The potentially devastating complication of total or near total thoracic endoprosthesis collapse has been described with the TAG device (W. L. Gore & Associates, Flagstaff, Ariz). This rare complication has resulted in a warning to clinicians and speculation about the etiology of this problem. This report evaluates potential causative anatomic factors that may increase the probability of endoprosthesis collapse in patients undergoing endovascular thoracic aneurysm repair (TEVAR).
Methods
Preoperative and postoperative computed tomography scans were collected worldwide representing six patients who had experienced radiologically confirmed TAG endoprosthesis collapse. These were compared with a matched cohort of five patients with a TAG endoprosthesis in the same anatomic position in which no collapse occurred. Anatomic variables of aortic arch angulation, apposition, intraluminal lip length, proximal aortic diameter, distal aortic diameter, intragraft aortic diameter, percentage of oversizing, and angle of the proximal endograft to the aortic arch were compared between groups. Differences between groups were determined using the Student t test, with P < .05 considered significant.
Results
The two groups (collapse vs no collapse) were evenly matched demographically, and all underwent endoluminal treatment with the TAG device, with no differences in gender, graft position in the aorta, operative indication, or age (P = NS). Distal sealing zone aortic diameter ± standard deviation of 18.9 ± 1.7 mm vs 22.7 ± 2.7 mm and minimum aortic diameter within the endograft of 18.6 ± 1.7 mm vs 22.4 ± 3.1 mm predicted collapse (P < .05). Proximal aortic diameter, apposition, intraluminal lip length, aortic arch angle, and angle of proximal endograft to aortic arch did not predict collapse (P = NS).
Conclusion
Thoracic endograft collapse is an exceedingly rare event. In this series, endoprosthesis collapse occurred in patients who were treated outside the manufacturer’s instructions for use for minimum required aortic diameter. Although distal aortic diameter and minimum intragraft aortic diameter predicted collapse, other variables may also influence this complication but were not significant owing to potential type II statistical errors. In the future, caution should be exercised when contemplating TEVAR in patients with small (<23 mm) aortic diameters.
aDivision of Vascular Surgery, New York University School of Medicine, New York, NY
bDepartment of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands
cDepartment of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, Australia
dDepartment of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Reprint requests: Hence J. M. Verhagen, MD, PhD, Department of Vascular Surgery, G.04.129, University Medical Center Utrecht, PO Box 85500, 3508GA Utrecht, The Netherlands.
Competition of interest: Dr Muhs receives a speaking honorarium from W. L. Gore & Associates, and Drs White and Verhagen have consulting agreements with W. L. Gore & Associates.
Additional material for this article may be found online at www.jvascsurg.org.
ABSTRACT