Recurrent collapse of a Gore TAG endograft in treating an aortoesophageal fistula

As the utility of the Gore TAG endograft expands in an off-label fashion to include various aortic pathologies like aortoesophageal fistulas (AEFs), more TAG endograft collapses are being described in the literature. We report a case of a recurrent endograft collapse in a patient with a right-sided aortic arch, who was treated for a hemorrhage from an AEF. One month following the initial endograft placement, angiography detected infolding of the endograft, which was then re-expanded with another endograft. Four months later, the patient developed an acute biventricular dysfunction with an ejection fraction (EF) less than 20%. Cardiac catheterization revealed that the patient had an 80mmHg pressure gradient across the endograft suggesting another collapse. A balloon-expandable stent was used to re-expand the endografts and restore the EF. On follow-up, the patient's endograft has remained patent without evidence of further collapse.