Endograft malapposition in the distal aortic arch resulting in functional coarctation

The application of thoracic endografts to thoracic aortic injuries is often limited by the available diameters of these devices. Abdominal aortic endografts have been successfully used in the thoracic aorta to overcome sizing limitations. A case is presented of a patient who underwent endovascular exclusion of a thoracic aortic transection with an abdominal aortic endograft iliac limb. The repair was complicated by endograft malapposition to the lesser curvature of the aortic arch and the development of a functional coarctation. The endovascular repair was successfully salvaged through the use of a balloon-expandable stent to improve endograft apposition to the vessel wall.