Anatomic factors associated with acute endograft collapse after Gore TAG treatment of thoracic aortic dissection or traumatic rupture

Measurements included (A) aortic arch angulation, (B) angle of endograft extending into the aortic lumen, (C) endograft lip length, (D) confirmation of infolding, presence of motion artifact, endograft distance from the subclavian artery, and aortic diameters perpendicular to the center lumen line at the proximal, intragraft, and distal landing zones.

A-D, Representative images of the collapsed endoprosthesis in four patients are shown.

In one patient, attempts were made to correct the graft infolding through endovascular salvage with the implantation of additional endoprosthesis inside a collapsed TAG. This attempt was unsuccessful. A, A TAG (28 mm × 10 cm) was deployed first, but owing to a proximal type I endoleak, a second TAG (28 mm × 15 cm) was deployed slightly more proximally. B and C, Computed tomography (CT) imaging showed clear infolding of the second TAG. D, To treat the infolding, a giant Palmaz stent was deployed. A CT scan 1 day after the placement of the Palmaz stent showed complete infolding of both the second TAG as well as the Palmaz stent.

Attempts were made in one patient to correct the graft infolding by using endovascular salvage with additional balloon angioplasty inside a collapsed TAG. This attempt was successful. A, Infolding was observed on the postoperative computed tomography (CT). B, The patient was taken back to the operating room for balloon angioplasty. C, The follow-up CT scan after balloon angioplasty demonstrated correction of the infolding.

Open explant and repair was performed successfully in one patient. The explanted stent graft demonstrated infolding and two rows of fractured stents.