dacron arterial grafts are widely used in thoracic aortic replacement , but few cases of non - anastomotic aneurysmal dilatation or rupture have been reported . in most cases that have been reported , knitted , rather than woven ,
we report the clinically successful result of thoracic endovascular repair ( tevar ) of the late rupture of a woven dacron graft .
the dacron graft had been implanted in the patient s descending thoracic and upper abdominal aorta 20 years previously . a 56-year - old man with
a descending thoracoabdominal aortic aneurysm underwent descending thoracic and upper abdominal aorta replacement with a hemashield 20-mm woven dacron graft ( meadox medicals inc . ,
he was followed up as an outpatient , and no adverse events were noted until 2009 , when he presented with sudden - onset chest pain and severe dyspnea . at that time , chest computed tomography ( ct ) revealed a massive right hemothorax , a large pseudoaneurysm around the implanted graft just above the diaphragm level , and marked contrast medium extravasation from the graft ( fig .
1 ) . the patient underwent an emergency open thoracotomy , in which a disruption was found at the site of the anastomosis between the dacron graft and lumbar intercostal arteries .
the disrupted site was repaired with 2 layers of running sutures , and the graft was wrapped with the calcified aneurysmal sac . in 2012 ,
the patient presented with back pain , abdominal pain , and indigestion . a follow - up chest ct revealed that the size of the aneurysm in the descending aorta had increased in comparison with the findings of the previous ct examination .
dye collection in the space between the graft and native aneurysmal sac was also observed , and was suspected to be indicative of a late rupture of the dacron graft itself ( fig .
the rupture was unrelated to the previous anastomosis or disrupted site . due to the high morbidity and mortality associated with reoperation
, we decided to perform thoracic endovascular stent therapy as an alternative to open thoracotomy for the late graft failure .
the primary goal of using tevar was to cover the entire length of the dacron graft in the descending aorta with a stent graft .
the right common femoral artery was exposed under general anesthesia , and a guidewire and angiographic catheter were introduced through it .
aortic angiography revealed multiple dye leakages from the graft that were caused by late failure of the dacron graft ( fig .
3 ) . after obtaining an aortogram , two stent grafts ( 3030150 mm and 3636100 mm ; s&g biotech inc . ,
seongnam , korea ) were also introduced through the right femoral artery and placed in the dacron graft .
the proximal end of the stent graft was deployed distally to the left subclavian artery , and the distal end was placed just above the celiac trunk .
the total length of the thoracoabdominal aorta covered by the stent graft was approximately 220 mm .
a postoperative ct scan showed that the disruption of the dacron graft had been successfully treated ( fig .
the patient was discharged with no procedure - related complications and , during the 1-year follow - up period , was free of any symptoms .
dacron vascular grafts are known to be durable and effective as aortic vascular prostheses . however , a few cases of non - anastomotic aneurysmal dilatation or rupture of these grafts after implantation in the descending thoracic aorta have been reported .
the probable cause was degeneration over time of the graft fibers or the round black yarn used as the guideline .
intrinsic graft failure of dacron grafts is a rare complication ( 0.5%3% ) ; and in most reported cases , knitted , not woven , dacron grafts had been used . in our case ,
woven dacron graft rupture occurred 20 years after the initial operation , probably caused by the degeneration of graft fibers over a long time .
although woven dacron graft rupture is extremely rare , reoperation is inevitable when it does occur .
however , the hospital mortality after aortic reoperation remains high ( 8%15% in many reports ) , and is even higher ( 25%50% ) among patients receiving urgent or emergency care .
tevar is increasingly being used for descending aortic diseases as a safe and feasible alternative to open graft repair . in light of the high morbidity and mortality associated with reoperation
, we decided to perform endovascular therapy as an alternative management strategy for late graft failure in our patient .
to the best of our knowledge , the endovascular repair of primary graft rupture in a woven dacron graft has not been reported .
the case presented here demonstrates the effectiveness and feasibility of tevar implantation to treat the non - anastomotic rupture of a dacron graft after descending aortic replacement .
 the intrinsic structural failure of a dacron graft resulting from the loss of structural integrity of the graft fabric can cause late graft complications . 
 late non - anastomotic rupture has traditionally been treated surgically via open thoracotomy . 
 we report a case of the successful use of thoracic endovascular repair to treat a dacron graft rupture in the descending aorta . 
 the rupture occurred 20 years after the graft had been placed . 
 two stent grafts were placed at the proximal portion of the surgical graft , covering almost its entire length . 
Case report
Discussion