Julia Lortz1, Felicitas Leinburger1, Konstantinos Tsagakis2, Christos Rammos1, Alexander Lind1, Thomas Schlosser3, Heinz Jakob2, Tienush Rassaf1, Rolf Alexander Jánosi4. 1. Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Centre Essen, University of Duisburg-Essen, Essen, Germany. 2. Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre Essen, University of Duisburg-Essen, Essen, Germany. 3. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany. 4. Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Centre Essen, University of Duisburg-Essen, Essen, Germany. Electronic address: alexander.janosi@uk-essen.de.
Abstract
OBJECTIVES: Distal stent graft induced new entry (dSINE) is a rare complication associated with acute and chronic dissections after thoracic endovascular aortic repair (TEVAR) and is linked to a high re-intervention rate. The potential predicting risk factors for dSINE and long term outcome of patients after re-intervention were analysed. METHODS: This single centre, retrospective study included patients undergoing TEVAR. Multivariable analysis was used to test important interventional parameters such as distal oversizing (dOS), taper ratio (TR), angle between distal stent graft and aorta, acute dissection and stent graft length. Re-intervention characteristics were analysed and further long term follow up after re-intervention were evaluated. RESULTS: One hundred and eighty-five patients were analysed with acute (n = 77) and chronic (n = 108) dissections after TEVAR with an average follow up of 68.9 ± 32.5 months. During follow up, 12 (6.5%) patients developed dSINE after a median of 22.2 ± 20.7 months. Acute dissection was identified as a major predicting factor for dSINE development (15.8 fold increased odds), followed by increased dOS and TR. The re-intervention rate was higher in the dSINE group (83% vs. 20%, p = .001), but results indicated that no further re-intervention was needed and no new endoleak development occurred up to a mean follow up of 60.7 ± 54.8 months. No dSINE was seen in association with tapered stent grafts. CONCLUSIONS: Acute aortic dissection was found to be the major predicting factor for dSINE development, followed by increased dOS and TR. The use of tapered stent grafts might be beneficial for patients with high expected dOS and TR. In the rare case of dSINE occurrence, even when re-intervention is required, the long term prognosis is good.
OBJECTIVES: Distal stent graft induced new entry (dSINE) is a rare complication associated with acute and chronic dissections after thoracic endovascular aortic repair (TEVAR) and is linked to a high re-intervention rate. The potential predicting risk factors for dSINE and long term outcome of patients after re-intervention were analysed. METHODS: This single centre, retrospective study included patients undergoing TEVAR. Multivariable analysis was used to test important interventional parameters such as distal oversizing (dOS), taper ratio (TR), angle between distal stent graft and aorta, acute dissection and stent graft length. Re-intervention characteristics were analysed and further long term follow up after re-intervention were evaluated. RESULTS: One hundred and eighty-five patients were analysed with acute (n = 77) and chronic (n = 108) dissections after TEVAR with an average follow up of 68.9 ± 32.5 months. During follow up, 12 (6.5%) patients developed dSINE after a median of 22.2 ± 20.7 months. Acute dissection was identified as a major predicting factor for dSINE development (15.8 fold increased odds), followed by increased dOS and TR. The re-intervention rate was higher in the dSINE group (83% vs. 20%, p = .001), but results indicated that no further re-intervention was needed and no new endoleak development occurred up to a mean follow up of 60.7 ± 54.8 months. No dSINE was seen in association with tapered stent grafts. CONCLUSIONS: Acute aortic dissection was found to be the major predicting factor for dSINE development, followed by increased dOS and TR. The use of tapered stent grafts might be beneficial for patients with high expected dOS and TR. In the rare case of dSINE occurrence, even when re-intervention is required, the long term prognosis is good.