Film analysis summary: the exact cause of the tip capture mechanism becoming stuck on the stent graft during removal of the delivery system, leading to a possible type ia endoleak, could not be determined from the pre-implant films provided.Images during implant and ct¿s post-implant were not available for review, and the reported event could not be assessed.Returned pre-implant ct¿s revealed that the patient had a 53mm max diameter taa at the top of the arch, as well as a 67mm max diameter taa located ~8cm distal to the arch within the proximal portion of the descending thoracic.The thoracic was also severely tortuous distal to these aneurysms.Distal to the planned distal landing zone the thoracic was acutely angulated ~90 deg (horizontal), and a second >130 deg bend was observed within the descending thoracic with associated vessel narrowing to ~18mm at this acute bend.The delivery system was reported as bent in multiple locations after it was removed from the patient; it is likely that the severe vessel tortuosity led to the delivery system kinks which may have been a contributing factor of the removal difficulties.This event is also potentially procedure/user related.A device issue cannot be ruled out as a potential cause.However, the delivery system was discarded and product investigation could not be performed.Additional information: it was reported that the delivery system appeared to be bent in multiple locations after it was removed from the patient, no additional clinical sequalae were reported.It was reported that bailout procedures were not used and that the wire was retracted.It was noted that forward pressure was relieved but that the anatomy was so tortuous that the system had built up forward tension.It was noted that when deploying the suprarenal stents, it appeared that one did not detach from the delivery system.If information is provided in the future, a supplemental report will be issued.
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