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Thoracic aortic aneurysm expansion due to late distal stent graft‐induced new entry

2014; Wiley; Volume: 85; Issue: 2 Linguagem: Inglês

10.1002/ccd.25614

1522-726X

Rolf Alexander Jánosi, Konstantinos Tsagakis, Markus Bettin, Philipp Kahlert, Michael Horacek, Fadi Al‐Rashid, Thomas Schlosser, Heinz Jakob, Holger Eggebrecht, Raimund Erbel,

Infectious Aortic and Vascular Conditions

Objectives This study analyzed the mechanism and risk factors of thoracic aortic aneurysm expansion due to late distal stent graft‐induced new entry (dSINE). Background This late complication of thoracic endovascular aneurysm repair (TEVAR) for aortic dissection is under‐recognized but potentially life‐threatening. Methods In 142 patients who underwent TEVAR with endovascular entry sealing for acute and chronic aortic type B dissection, using commercially available straight (nontapered) stent‐grafts, we examined the oversizing rate, the aortic taper ratio, and the need for reintervention. Results Nine of 142 patients developed thoracic aortic aneurysm expansion due to dSINE after TEVAR. The median follow‐up was 47.5 ± 37.4 months. There was a significant difference in the distal stent–aorta angle between the patients with and without dSINE (149.08 ± 15.09° vs. 166.72 ± 12.47°, P < 0.005). Patients with dSINE showed a significantly higher taper ratio of the true lumen of the aorta (40.9 ± 14.13% vs. 25.36 ± 20.2%, P < 0.05). There was also a significant difference in the oversizing of the stent‐graft in the distal landing zone (95.88 ± 49.3% vs. 55.94 ± 36.23%, P < 0.01). All patients with dSINE underwent a secondary endograft procedure without any complications or deaths. In 7 cases we used a custom‐made, highly tapered stent‐graft. Conclusions Lifelong follow‐up of patients is mandatory after TEVAR. A stent‐graft with a tapered design should be used in aortic dissection to avoid oversizing and devastating late complications. © 2014 Wiley Periodicals, Inc.