Two autopsy cases of rupture of the aorta by fistula formation after thoracic endovascular aortic repair and open stent-grafting on aortic arch aneurysm

• Published in: Cardiovascular pathology Vol. 39; pp. 61 - 66
• Main Authors: Mori, Shinjiro, Kimura, Satoko, Ro, Ayako, Hayakawa, Akira, Funakoshi, Izumi, Fukunaga, Tatsushige, Mizukami, Hajime
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2019
• Subjects: Aortic esophageal fistula; Aortopulmonary fistula; Autopsy; Open stent-grafting; Thoracic endovascular aortic repair; Aortopulmonary fistula; Thoracic endovascular aortic repair; Aortic esophageal fistula; Autopsy; Open stent-grafting
• ISSN: 1054-8807; 1879-1336
• DOI: 10.1016/j.carpath.2018.12.007

The mortality rate of aortic aneurysm/dissection is low in Japan. Two surgical procedures, the thoracic endovascular aortic repair (TEVAR) and the open stent-grafting have contributed much in survival of such aneurysmal patients. We encountered with two autopsy cases of death by aortic rupture with fistula formation after these procedures. Case 1 is an 85-year-old male who had the history of TEVAR for thoracic aorta aneurysm one and a half year before his death. His endovascular stent-graft was composed of a steel endoskeleton consisting of six Z-shape elements while at autopsy, one of the elements locating at the distal part was found inserted deep into the wall of descending aorta, causing aorto‐esophageal fistula. Case 2 is an 88-year-old male who had the history of open stent-grafting for aortic aneurysm eight years ago. At autopsy, the stent-graft was found detached from aorta at its lesser curvature, causing gap formation between the aorta and the stent. Six Z-shaped stent elements, the parts of stent-graft, were found separated from descending aorta and located in the aneurism. Furthermore, three of the separated elements were found inserted deep in the aortic wall, causing aorto‐pulmonary fistula. Since aorto‐esophageal fistula formation after surgery for aortic aneurysm is very rare in TEVAR and there are no reported cases of death by aorto‐pulmonary fistula in the open stent-grafting, these cases are reported here. •Two autopsy cases of death by fistula formation after TEVAR and open stent-grafting•TEVAR case was causing aorto‐esophageal fistula by the distal part of stent-grafting.•Open stent-grafting case was causing aorto‐pulmonary fistula by stent-grafting.