Stent-graft migration during endovascular repair of aortic dissection

Objective To evaluate the cause and management of intraoperative stent-graft migration during endovascular repaire of aortic dissection (AD). Method During the period between May 2001 and Dec 2007 intraoperative stent-graft migration occurred in 17 cases ( 14 males and 3 females) including 15 acute AD cases and 2 chronic AD cases. Backward migration was noticed in 11 cases including the 2 cases found during balloon extention, in 1 case the migration found during the removal of the releasing sheath which scratched the stent-graft, in 2 cases the migration occurred when the grafts were half released. Forward migration occurred in 6 cases resulting in left subclavian artery (LSA) occlusion in 3 cases and left common carotid artery (LCCA) occlusion in the other 3 cases. For the 3 cases of LCCA occlusion, the backward migrated stent-graft was pushed forward by the cuff releasing system and consequently occluded the LCCA in 1 case, and the cuff jumped forward during release and occluded the LCCA in 1 case. Result Backward migration of stent-grafts can be treated by pushing forward the graft with the sheath or additional placement of a cuff. Intraoperative complication may be less life threatening and no perioperative death occurred in this group. Occlusion of LSA in 3 cases by forward migration of stent-grafts were left untreated and 1 case died of leter cerebellar infarction. For the LCCA occlusion in 3 cases, 2 were treated by drawing back the graft with a balloon, and in the remaining 1 case the migrated graft was pushed back with the catheter in the LSA captured by a snare. Conclusion Stent-graft migration during endovascular repair may be related with poor experience of the operator, specific anatomical condition of the patient and the design drawback of the stent-graft. Forward migration of stent-graft is less common but may be more harmful for the patient. Beside back drawing with a balloon, the captured catheter with a snare may be helpful in the management of forward migration of the released stent graft. Key words: Aneurysm, dissecting;  Intraoperative complication;  Stents;  Endovascular repair;  Migration