Inverted Thoracic Stent Graft Technique for Separation of a Stent Graft and Bare Stent Caused by Aortic Elongation

Component separation (CS) of the Zenith Dissection Endovascular Graft and Stent have been reported with some causes. However, CS caused by aortic elongation has not yet been reported. A long treatment range with the sacrifice of some intercostal arteries (ICAs) is sometimes needed when repairing CS because of the large difference in the diameter between the proximal and distal landing zones with a reverse taper. A 78-year-old man, who underwent thoracic endovascular aortic repair (TEVAR) using a Zenith Dissection Graft and stents for acute type B aortic dissection 3 years and 8 months previously was admitted to our hospital with severe back pain. Contrast-enhanced computed tomography (CT) showed separation of the SG and bare stent, and aortic elongation. As there was a large difference in the diameter of the proximal and distal landing zones with a reverse taper, a long treatment range with the sacrifice of two large ICAs was needed. Thus, TEVAR using an inverted thoracic SG technique was performed in order to shorten the treatment range to preserve a large ICA and reduce the risk of paraplegia. Completion angiography showed that the separation was repaired with preservation of the large ICA. The postoperative course was uneventful, and he was discharged on postoperative day 10 with relief of his severe pain. At 1 year after secondary TEVAR, CT showed that the diameter of the descending aorta had decreased with no separation of the SGs. Deployment of an inverted thoracic SG for the treatment of CS of the Zenith Dissection Endovascular Graft and Stent is a feasible and effective procedure to preserve ICAs. An overlapping range of >1.5 times the length of a bare stent within an SG is needed to prevent CS of the Zenith Dissection Endovascular Graft and Stent caused by aortic elongation.