Stent-Graft Fracture 18 Years After Hybrid Repair of Thoracoabdominal Aortic Aneurysm: A Possible Risk of Retrograde Reconstruction

We report the case of a patient who underwent hybrid repair for a type V thoracoabdominal aortic aneurysm. The procedure ensured durable aneurysm exclusion and visceral perfusion for 18 years. Eighteen years after surgery, the stent-graft fractured occurred at the visceral artery segment. Fluid-structure interaction analysis revealed a progressive elevation of von Mises stress at the eventual fracture site. Compared with in situ reconstruction, retrograde reconstruction in hybrid repair may increase the risk of stent-related complications. Monitoring von Mises stress during follow-up may help predict fracture and allow early intervention. Clinical Impact Late stent-graft fracture after hybrid repair can occur despite effective aneurysm exclusion and satisfactory visceral perfusion. This case highlights the importance of long-term surveillance of graft integrity and changes in aortic morphology. A gradual increase in tortuosity and progressive elongation of the aorta may warrant particular attention, even many years after surgery. Fluid–structure interaction analysis linked progressive elevation of von Mises stress to the eventual fracture site and suggested that retrograde reconstruction may increase localized stress compared with in situ reconstruction. Integrating longitudinal imaging with patient-specific stress analysis may help clinicians recognize graft segments that warrant closer follow-up.