Reintervention for distal stent graft-induced new entry after endovascular repair with a stainless steel-based device in aortic dissection

J Vasc Surg. 2013 Jan;57(1):64-71. doi: 10.1016/j.jvs.2012.07.006. Epub 2012 Nov 7.

Abstract

Objective: Stent graft-induced new entry (SINE) has been increasingly observed after thoracic endovascular aortic repair (TEVAR) for aortic dissection. We investigated the mechanism of late distal SINE, prevention strategies, proper size selection of the stent graft, and implantation sequence.

Methods: From November 2006 to May 2011, 99 patients with aortic dissection underwent TEVAR with Zenith TX2 stent grafts (Cook, Bloomington, Ind) at our center. Among them, 27 distal SINEs were recognized. Eight of these patients with complicated distal SINE required intervention with new distal endografts, and all were enrolled for further analysis.

Results: Eight of the 27 patients with distal SINE underwent a secondary endograft procedure from February 2011 to July 2011. All were successfully treated without any complications or deaths. A high taper ratio (35%±11%) and excessive oversizing of the true lumen area at the distal stent level (293%±76%) were noted among these patients.

Conclusions: The incidence of distal SINE seemed to be high; however, there were also low rates of death and complications after TEVAR for aortic dissection using stainless steel-based stent grafts. Complicated distal SINE can successfully be resolved by distal endograft implantation. Excessive oversizing of the distal stent graft, as measured by the true lumen area, may be a significant factor causing delayed distal SINE. Precise size selection is crucial for the distal end of the stent, especially for high taper ratio dissection pathology in which the implantation sequence of a distal small-sized stent graft first might be considered to prevent future distal SINE.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aortic Aneurysm, Thoracic / diagnostic imaging
  • Aortic Aneurysm, Thoracic / surgery*
  • Aortic Dissection / diagnostic imaging
  • Aortic Dissection / surgery*
  • Aortography / methods
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / instrumentation*
  • Blood Vessel Prosthesis*
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / methods*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Postoperative Complications / diagnostic imaging
  • Postoperative Complications / etiology
  • Postoperative Complications / surgery*
  • Prosthesis Design
  • Reoperation
  • Stainless Steel*
  • Stents*
  • Time Factors
  • Tomography, Spiral Computed
  • Treatment Outcome

Substances

  • Stainless Steel