LATE AORTIC-ARCH PERFORATION BY GRAFT-ANCHORING STENT - COMPLICATION OF ENDOVASCULAR THORACIC ANEURYSM EXCLUSION

Purpose: To describe a fatal case of late aortic perforation by an end ograft-anchoring stent. Methods and Results: A 69-year-old woman prese nted 2 years after thoracoabdominal aneurysm repair with a 9-cm dilata tion of the descending thoracic aorta proximal to the conventional aor tic graft. A 38-mm Dacron graft with multiple Gianturco Z-stents sutur ed inside was placed transluminally across the aortic arch such that p art of the uncovered portion of the proximal stent was partially acros s the left subclavian orifice. Four months later, the patient died fro m massive hemorrhage. Autopsy showed that the uncovered portion of the proximal stent had perforated the aortic arch. Conclusions: This case stresses the need for low-profile stent-grafts and smaller, more flex ible introducer systems. Anchoring stents must be flexible, less traum atic, and strong enough to create a watertight seal even in tortuous v essels. To avoid aortic arch damage by thoracic stent-grafts, the prox imal stent should be fully covered by the fabric.