Late retrograde aortic perforation by the uncovered part of an endograft: an increasing complication

A 56-year-old man, known for type B aortic dissection, was treated 3 years before with a Talent endograft (Medtronic, Minneapolis, USA) in the descending aorta. He presented with tamponade caused by the perforation of the aortic intima by the uncovered stent strut. The ascending aorta and part of the aortic arch were replaced. The operation and recovery were uneventful. To avoid aortic arch damage by thoracic stent-grafts, the proximal stent should be fully covered. In addition we should be very cautious about the proximal landing zone of the stent, which should not be on the curved portion of the aorta.