: Case 1; A male Marfan patient was operated for thoraco-abdominal
aneurysm. On computed tomography (CT), large
false aneurysm at the proximal anastomosis was documented which was excluded with a 30 mm Talent
stent-graft with 10-15% oversize. Case 2; A female with
Ehlers-Danlos syndrome had undergone resection of descending aortic thoracic
aneurysm presented with an enlarging
aneurysm distal to the graft. Three Talent
stent-grafts (15% oversize) were deployed with balloon dilatation to exclude the
aneurysm. The immediate postoperative period was complicated by an extensive intramural
hematoma of the descending aorta with
hemothorax, managed conservatively. Case 3; A female Marfan patient had undergone Bentall procedure and mitral repair followed with resection of the proximal descending aorta. Three months later a
false aneurysm at the distal anastomosis was treated with a 24 mm Valiant
stent-graft (30% oversize).
Aortic dissection distal to
stent was documented on the early postoperative CT. The dissected
aneurysm enlarged significantly with a type I distal
endoleak during follow-up. Concomitantly, the patient presented a class III
dyspnea owing to a severe
mitral regurgitation. The patient underwent a successful MVR and
stent-graft explantation with replacement of the descending aorta.
CONCLUSION: : Significant complications supervened when
stent-grafts were deployed in native aorta. We thus recommend that deploying a
stent-graft in a CTD diseased aorta should be considered a relative
contraindication. In cases with prohibitive or high risk surgery, use of a
stent-graft with minimal radial force and minimal oversizing without balloon dilatation should be considered.