Suitability and the unmet needs of current FDA-approved thoracic endografts

Arch of Conformation

There was a consensus that arch conformation represented the single greatest unmet need given the curvature of the thoracic aorta at the location of the injury. Inability to conform to this curvature can result in malapposition of the endograft, which can lead to endoleak and endograft collapse.

Oversizing

The aortic diameters are relatively smaller in the younger subset of trauma patients. Currently, available thoracic endograft sizes mostly reflect the larger aortic diameters that would be typically encountered in an older cohort with degenerative aneurysms. Excessive oversizing may result in attachment site endoleak, device infolding, endograft collapse, and even death from acute aortic occlusion. No consensus could be reached regarding optimal oversizing for these cases, and opinions were equally divided among minimal to no oversizing, 5% to 10% oversizing, and standard oversizing per manufacturer’s recommendations