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Thoracic aortic endograft explant: a single-center experience
Melissa L Kirkwood1, Alberto Pochettino, Ronald M Fairman
1Department of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. melissa.kirkwood@uphs.upenn.edu
Vascular and Endovascular Surgery
|June 4, 2010
Summary
Thoracic aortic endovascular repair (TEVAR) explant is rare but essential for complications like device issues or fistulas. While successful, explant procedures carry risks, necessitating careful consideration and surgical expertise.
Area of Science:
- Vascular Surgery
- Endovascular Repair
- Aortic Surgery
Background:
- Thoracic aortic endovascular repair (TEVAR) has become a common treatment for aortic pathologies.
- Complications requiring device explant are infrequent but can be severe.
Purpose of the Study:
- To review the experience with thoracic aortic endovascular repair (TEVAR) explant.
- To identify indications, techniques, and outcomes of TEVAR explant.
Main Methods:
- A retrospective review of 500 TEVAR procedures performed between 1999 and 2009.
- Analysis of four cases requiring TEVAR explant, focusing on indications, surgical techniques, and perioperative outcomes.
Main Results:
- Indications for explant included device maldeployment, endoleak, aortoenteric fistula, and retrograde type A dissection.
- Reconstruction involved aortic homograft, Dacron, or component explant with distal stent incorporation.
- One patient experienced paraplegia and perioperative death after conversion to open repair; all explants were successful.
Conclusions:
- TEVAR explant, though uncommon, requires familiarity due to expanding indications.
- Successful explant is achievable but associated with significant morbidity.