Bilateral Prosthetic Graft Stenosis After Supraaortic Debranching and Thoracic Endovascular Aortic Repair of the Transverse Arch.

A 66-year-old patient presented to the Leipzig Heart Center in Leipzig, Germany with therapy-refractory hypotension with a history of postural presyncope 7 years after supraaortic debranching and thoracic endovascular aortic repair of the transverse arch. Arterial angiography with invasive blood pressure measurement revealed pronounced hypertension of the lower body (blood pressure, 270/120 mm Hg) and subtotal prosthetic graft stenosis of the bypasses to the innominate artery and to the left common carotid artery. Open reoperation for removal of the stenosed Y-limb prosthesis and extraanatomic supraaortic revascularization was successfully performed. Subtotal prosthetic graft stenosis with need for reoperation may occur as a long-term complication after supraaortic debranching and thoracic endovascular aortic repair.