Hypoattenuated Intraluminal Deposits in Bridging Stents Used in Aortic Arch Surgery: Incidence, Predictors, and Clinical Impact

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All articles of this category (opens in new window) Background: The supraaortic vessel stent-bridging (SAVSTEB) technique employs self-expanding covered bridging stents to create sutureless anastomoses during aortic arch replacement. While complications of bridging stents, such as fractures, migrations, dissections, thromboses, embolization, and occlusions, are well known from endovascular use, data on their long-term surgical performance are limited. This study evaluated outcomes of SAVSTEB use with particular focus on hypoattenuated intraluminal deposits (HAID) detected on serial postoperative CT angiography (CTA). Methods: We retrospectively analyzed all patients who underwent SAVSTEB between January 2011 and June 2025. Demographics, comorbidities, surgical techniques, postoperative anticoagulation, and follow-up results were collected. HAID was defined as partial intraluminal hypoattenuation on follow-up CTA. Neurological events (stroke, TIA) were correlated with imaging findings. Statistical analysis included univariate and linear regression models. Results: A total of 201 patients (mean age 60 ± 13 years, 69% male, BMI 27 ± 0.36 kg/m 2 ) received 363 stents and were followed for a mean of 1,672 ± 284 days. The only complication of relevant incidence was HAID, occurring in 33 stents (9%) at a mean of 571 ± 108 days, most often in the left carotid artery (70%). Acute type A dissection was the sole independent predictor ( p = 0.004). HAID correlated with shorter ICU stays, reduced erythrocyte transfusions, and increased platelet transfusions (all p < 0.05), but was unaffected by postoperative anticoagulation. Neurological events occurred in 32 patients (16%), and mortality among those with HAID was 15%. Conclusion: Intraluminal deposits are an uncommon but important late complication of bridging stents after SAVSTEB, arising in fewer than one in ten cases, usually beyond the first year. Other endovascular stent-related complications were not observed. These findings confirm the SAVSTEB technique as a durable and safe method of supra-aortic reconstruction with follow-up up to 14 years. However, HAID requires ongoing surveillance, as its occurrence appears influenced more by perioperative than by long-term antithrombotic factors. The association with specific transfusion patterns and shorter ICU stays suggests a potential interaction with early heparin use that warrants further study. Long-term monitoring and optimization of perioperative strategies remain essential to minimize risk and preserve the excellent durability of SAVSTEB reconstructions. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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