Endovascular Repair of a Huge False Aneurysm From an Ascending Aortic Prosthesis: Off-Label Use of the New Gore® Aortic Extender.

Abstract

In this case report, we describe the feasibility and technical considerations of an off-label use of the new Gore^® Aortic Extender (W.L. Gore & Associates), which is part of the Gore^® TAG^® Thoracic Branch Endoprosthesis (W.L. Gore & Associates), to repair a huge false aneurysm originating from an ascending aortic prosthesis. The patient's medical history reported an acute type A aortic dissection 10 years ago, for which he was treated with a Bentall procedure. This was complicated by obstruction of the left main coronary after it was reconstructed and thus a coronary artery bypass was also performed. During follow-up, a huge false aneurysm of 11 cm was found, caused by a dehiscent saphenous vein graft on the Bentall prosthesis. Since the patient was clearly not fit for redo surgery, we decided to treat this patient endovascularly with the Gore^® Aortic Extender (W.L. Gore & Associates). This cuff has recently been introduced and is off-the-shelf available and seemed to fit perfectly in this patient.Clinical impactWith the introduction of the new, Gore^® TAG^® Thoracic Branch Endoprosthesis (W.L. Gore & Associates), a very short endoprosthesis became available for proximal extension of the Thoracic Branch Endoprosthesis. This graft, the Gore^® Aortic Extender (W.L. Gore & Associates) seems to come in favorable sizes for the ascending aorta. As long as dedicated endoprosthesis for the ascending aorta are not off-the-shelf availabe, off-label use of such endovascular devices is an useful option whenever open surgery seems too high risk.