[Transcatheter stent-graft implantation for the treatment of acute aortic dissection--rupture of aneurysm because of perigraft leakage].

An 82-year-old woman was diagnosed as having acute type B aortic dissection. At bed rest, her systolic blood pressure was kept less than 120 mmHg. Four days later the aneurysm threatened to rupture. Because she presented a high operative risk for open-chest surgery, a stent-graft was implanted across the dissection site via transcatheter. The entry site to the aneurysm was closed by the stent-graft, and postoperative aortograph demonstrated that contrast medium did not enter the false lumen except for a trivial projection. A CT scan 6 days after the stent-graft implantation unexpectedly demonstrated the false lumen not only had not thrombosed, but had expanded. As a result, 8 days after the operation the aneurysm ruptured into the left pleural cavity, and the patient died. An autopsy revealed the stent-graft was exactly implanted across the entry site, but that the diameter of the graft was slightly larger than that of the aorta. Consequently, a portion of the rim of the graft had been wraped after implantation, causing perigraft leakage. Leakage is one of the gravest complications of the stent-graft implantation, to prevent it, a new design for stent-graft device is essential.