Fecha de la publicación: 23/02/2019
Autor: África Duque Santos (1), Andrés Reyes Valdivia (2), Sergio Gordillo Alguacil (2), Julia Ocaña Guaita (2), Claudio Gandarias Zúñiga (2)
1Department of Vascular and Endovascular Surgery, Ramón y Cajal’s University Hospital, Madrid, Spain. Electronic address: firstname.lastname@example.org.
2Department of Vascular and Endovascular Surgery, Ramón y Cajal’s University Hospital, Madrid, Spain.
Background: Aortic bare-metal stent rupture is an exceptional complication, associated with high risk of aorta rupture and death. We describe a successful endovascular approach for a symptomatic aortic bare-metal stent fracture after the provisional extension to induce complete attachment (PETTICOAT) technique.
Methods: A 53-year-old man with a complicated type B aortic dissection (visceral malperfusion) was treated with thoracic endovascular aortic repair (TEVAR) and «PETTICOAT» technique. The 1-, 6-, and 12-month follow-up scans showed progressive aortic remodeling. After 15 months from the initial procedure, the patient was admitted to the emergency department with severe thoracic pain and two syncopal episodes. Urgent angio-computed tomography (CT) showed bare-metal stent rupture and aortic dilatation to 45 mm at the site of stent fracture.
Results: He was urgently treated with TEVAR to cover the entire length of the bare-metal stent under local anesthesia and motor-evoked potential (MEP) monitoring. If signs of medullary ischemia are observed in the MEP register, a carotid-subclavian bypass was planned. At 12 months of follow-up, the patient remains asymptomatic. CT scan at 1 month and 12 months showed no signs of endoleak and aortic remodeling to 40 mm.
Conclusions: Although unusual, this case demonstrates the possibility of material fatigue/failure and highlights the need of close imaging follow-up after TEVAR for treatment of aortic diseases.
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