Thoracic aortic endograft explant: A single-center experience

Objectives: We report our experience following thoracic aortic endovascular repair (TEVAR) explant. Methods: A total of 500 TEVARs were performed from 1999 to 2009, with 4 requiring explant. Chart review was performed to identify the indications of explant, operative technique, and perioperative morbidity and mortality. Results: Indications of graft removal included device maldeployment, type I endoleak, aortoenteric fistula, and retrograde type A dissection necessitating aortic root replacement. Reconstruction was achieved with aortic homograft, Dacron, or explant of the proximal component with incorporation of the distal stent into the suture line. Mean follow-up was 13 months (0-50 months). Paraplegia and perioperative death occurred in 1 patient who underwent intraoperative conversion to open repair. There were no other major complications, and graft removal was achieved in all patients. Conclusions: Although rare, familiarity with TEVAR explant is imperative as it is increasingly performed for broader indications. Our limited data suggest that explant can be performed successfully albeit with morbidity.