Thorac Cardiovasc Surg 2014; 62 - SC16
DOI: 10.1055/s-0034-1367277

Vertebral body erosion in a 27-year old female 12 years after thoracic endovascular aortic repair

M. Luehr 1, C.D. Etz 1, L. Lehmkuhl 2, K. von Aspern 1, F.F. Girrbach 1, A. Hoyer 1, M.A. Borger 1, F.-W. Mohr 1
  • 1Herzzentrum Leipzig - Universitätsklinik, Klinik für Herzchirurgie, Leipzig, Germany
  • 2Herzzentrum Leipzig - Universitätsklinik, Abteilung für Radiologie, Leipzig, Germany

Introduction: Twelve years after severe blunt chest trauma a 27-year old female presented with persisting, medically refractory back pain. The patient had been one of the first adolescents to be treated by thoracic endovascular aortic repair (TEVAR) for acute rupture of the aortic isthmus-covering the distal aortic arch down to the thoracic level of Th7. First symptoms of back pain occurred 5 years after TEVAR and became progressively severe and she required medical and orthopedic therapy.

Background: At the age of 27, a CT scan revealed an erosion of the 7th thoracic vertebral body distally from the implanted stent-graft (Fig.1). Three-Dimensional CT reconstruction showed a broken bare spring at the distal end eroding the vertebral body, causing a state of chronic and progressively severe back pain. Open thoracic aortic repair was performed urgently to remove the stent and its remnants and replace the eroded aorta via a left lateral thoracotomy. Stent-graft removal was aggravated due to the severe adhesions triggered by chronic inflammation in close proximity of the stent-graft due to prosthetic failure, i.e. eroding broken bare springs and dissolving prosthetic material. The following clinical course was uneventful and the patient was discharged on POD#5.

Discussion: Open surgery remains the gold standard to treat thoracic aortic pathologies extending beyond the distal arch due to acceptable postoperative mortality and morbidity with excellent long-term outcomes. Despite a reported low early postoperative mortality, stent-grafts-if compared to open aortic surgery-tend to result in a higher incidence of long-term complications, e.g. endoleaks, device failure or migration, and aneurysm-related death. Since long-term outcome after TEVAR (>10 years) remains unknown, we believe that stent-grafts-especially in the very young-should only be used in life-saving clinical emergencies as severe collateral damage to adjacent mediastinal structures might occur unexpectedly.

Fig. 1