Document Detail


Incidence of and outcomes after misaligned deployment of the talent thoracic stent graft system.
MedLine Citation:
PMID:  20299179     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Various types of device-specific adverse events can occur during deployment of thoracic stent grafts due to the high flow rate and severe aortic angulation that is often encountered in the thoracic aorta. This study assessed the incidence, etiology, and overall effect of misaligned deployment of the Talent Thoracic Stent Graft (TSG) System. Techniques to predict and avoid this complication are discussed.
METHODS: Data collection included pivotal-trial follow-up, direct surveys of centers inside and outside the United States and principal investigators, a targeted literature search, and review of complaint files. Misaligned deployment was considered to occur when the proximal covered or uncovered stent apices of a thoracic stent graft folded back on itself and remained nonparallel to the wall of the aorta after deployment had been completed.
RESULTS: Of about 20,305 deployments to date of the Talent TSG, 24 misaligned deployments were identified for an incidence of 0.1%. Nineteen (79%) events occurred during treatment of degenerative aneurysms or penetrating ulcers, four (17%) during treatment of dissections, and the underlying pathology could not be determined for one patient. The misalignment was noted at the proximal end of the stent graft in 15 patients (63%), and the other 9 events (37%) occurred at the graft overlap junction. Two events were treated intraoperatively, with a second overlapping device placed in one patient and a snare used to reposition the proximal stent in another. Adverse clinical events occurred in three patients and included a persistent type I endoleak, continued false lumen perfusion in a patient with dissection, and delayed retrograde type A dissection in a patient undergoing total arch repair. No intraoperative contrast extravasation or computed tomography evidence of perforation was noted. There were no perioperative deaths or cerebrovascular events, with one report of paraplegia among the 24 patients in this series.
CONCLUSION: Misaligned deployment is an unusual phenomenon that tends to occur in the context of certain well-defined anatomic conditions in the thoracic aorta. To date, most of these events have not led to significant adverse sequelae. However, careful patient selection, periprocedural imaging, and case planning can help to identify anatomies in which misaligned opening is likely to occur, allowing physicians to avoid this complication.
Authors:
Karthik Kasirajan; Christopher J Kwolek; Naren Gupta; Ronald M Fairman
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Publication Detail:
Type:  Journal Article     Date:  2010-03-29
Journal Detail:
Title:  Journal of vascular surgery     Volume:  51     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-27     Completed Date:  2010-05-12     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1096-101     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Emory University School of Medicine, Atlanta, Ga, USA. karthik.kasirajan@emoryhealthcare.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Angiography / methods
Angioplasty / adverse effects*,  instrumentation,  methods
Aortic Aneurysm, Thoracic / mortality,  radiography,  surgery*
Blood Vessel Prosthesis Implantation / adverse effects*,  methods
Cohort Studies
Female
Follow-Up Studies
Humans
Incidence
Intraoperative Complications / epidemiology*,  etiology
Male
Middle Aged
Prosthesis Design
Prosthesis Failure
Registries
Risk Assessment
Severity of Illness Index
Stents*
Survival Analysis
Comments/Corrections
Comment In:
J Vasc Surg. 2010 May;51(5):1101-2   [PMID:  20420977 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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