Stent graft induced thoracic aortic contained rupture after 10 years follow-up triggered by endograft migration. A case report

Purpose Thoracic Aorta Endovascular Treatment (TEVAR) is nowadays the preferred option for the treatment of distal arch and descending thoracic aorta. TEVAR may be associated with long-term stent-graft failures. We hereby describe the case of a patient presented with a contained rupture of the descending thoracic aorta induced by the distal portion of the endograft, after 10-years from primary procedure. Case report A 72-years-old male patient was treated for a Penetrating Aortic Ulcer (PAU) located in zone 2 of the aortic arch with left carotid-subclavian-bypass and TEVAR. After 10-years of uneventful follow-up performed yearly by computed-tomography-angiography (CTA), without any sign of graft failure, the patient presented for routine control: TEVAR distal sealing zone was migrated, along with a stent-graft induced contained aortic rupture. Urgent repair was performed after establishing a axillary-femoral through-and-though-wire technique; a distal thoracic endograft was inserted with pairing delivery with the cranial introducer sheath, to obtain smooth positioning and successful relining. No complications occurred and the post-operative CTA showed exclusion of the aneurysm and complete sealing of the aortic rupture. Conclusions Even after a long-term and uneventful follow-up, TEVAR treatment may be associated with unexpected life-threatening failures. Follow-up is mandatory and advanced endovascular repair permits smooth endograft delivering and satisfactory outcomes.