Martin Czerny1, Holger Eggebrecht2, Herve Rousseau3, Paul Revel Mouroz3, Rolf-Alexander Janosi4, Mario Lescan5, Christian Schlensak5, Dittmar Böckler6, Marius Ante6, Emma Vdr Weijde7, Robin Heijmen7, Hans Henning Eckstein8, Benedikt Reutersberg8, Santi Trimarchi9, Jürg Schmidli10, Thomas Wyss10, Romina Frey10, Vladimir Makaloski10, Jan Brunkwall11, Spyridon Mylonas11, Zoltan Szeberin12, Josef Klocker13, Roman Gottardi14, Ingrid Schusterova15, Julia Morlock16, Tim Berger16, Friedhelm Beyersdorf16, Bartosz Rylski16. 1. Department of Cardiovascular Surgery, University Heart Centre Freiburg, Bad Krozingen, Germany. Electronic address: martin.czerny@universitaets-herzzentrum.de. 2. Cardioangiological Center Bethanien, Frankfurt, Germany. 3. Department of Radiology, Centre Hospitalier Universitaire de Rangueil, Toulouse, France. 4. Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany. 5. Department of Cardiothoracic and Vascular Surgery, University of Tübingen, Tübingen, Germany. 6. Department of Vascular Surgery, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany. 7. Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Germany. 8. Munich Aortic Centre, Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich Germany. 9. Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, Milan, Italy. 10. Department of Cardiovascular Surgery, Inselspital, University of Bern, Bern, Switzerland. 11. Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany. 12. Department of Vascular Surgery, Semmelweis University, Budapest, Hungary. 13. Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria. 14. Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University of Salzburg, Salzburg, Austria. 15. East Slovakian Heart Center, Košice, Slovakia. 16. Department of Cardiovascular Surgery, University Heart Centre Freiburg, Bad Krozingen, Germany.
Abstract
BACKGROUND: The study sought to learn about incidence and reasons for distal stent graft-induced new entry (dSINE) after thoracic endovascular aortic repair (TEVAR) or after frozen elephant trunk (FET) implantation, and develop prevention algorithms. METHODS: In an analysis of an international multicenter registry (EuREC [European Registry of Endovascular Aortic Repair Complications] registry), we found 69 dSINE patients of 1430 (4.8%) TEVAR patients with type B aortic dissection and 6 dSINE patients of 100 (6%) patients after the FET procedure for aortic dissection with secondary morphological comparison. RESULTS: The underlying aortic pathology was acute type B aortic dissection in 33 (44%) patients, subacute or chronic type B aortic dissection in 34 (45%) patients, acute type A aortic dissection in 3 patients and remaining dissection after type A repair in 3 (8%) patients, and acute type B intramural hematoma in 2 (3%) patients. dSINE occurred in 4.4% of patients in the acute setting and in 4.9% of patients in the subacute or chronic setting after TEVAR. After the FET procedure, dSINE occurred in 5.3% of patients in the acute setting and in 6.5% of patients in the chronic setting. The interval between TEVAR or FET and the diagnosis of dSINE was 489 ± 681 days. Follow-up after dSINE was 1340 ± 1151 days, and 4 (5%) patients developed recurrence of dSINE. Morphological analysis between patients after TEVAR with and without dSINE showed a smaller true lumen diameter, a more accentuated oval true lumen morphology, and a higher degree of stent graft oversizing in patients who developed dSINE. CONCLUSIONS: dSINE after TEVAR or FET is not rare and occurs with similar incidence after acute and chronic aortic dissection (early and late). Avoiding oversizing in the acute and chronic settings as well as carefully selecting patients for TEVAR in postdissection aneurysmal formation will aid in reducing the incidence of dSINE to a minimum.
BACKGROUND: The study sought to learn about incidence and reasons for distal stent graft-induced new entry (dSINE) after thoracic endovascular aortic repair (TEVAR) or after frozen elephant trunk (FET) implantation, and develop prevention algorithms. METHODS: In an analysis of an international multicenter registry (EuREC [European Registry of Endovascular Aortic Repair Complications] registry), we found 69 dSINE patients of 1430 (4.8%) TEVAR patients with type B aortic dissection and 6 dSINE patients of 100 (6%) patients after the FET procedure for aortic dissection with secondary morphological comparison. RESULTS: The underlying aortic pathology was acute type B aortic dissection in 33 (44%) patients, subacute or chronic type B aortic dissection in 34 (45%) patients, acute type A aortic dissection in 3 patients and remaining dissection after type A repair in 3 (8%) patients, and acute type B intramural hematoma in 2 (3%) patients. dSINE occurred in 4.4% of patients in the acute setting and in 4.9% of patients in the subacute or chronic setting after TEVAR. After the FET procedure, dSINE occurred in 5.3% of patients in the acute setting and in 6.5% of patients in the chronic setting. The interval between TEVAR or FET and the diagnosis of dSINE was 489 ± 681 days. Follow-up after dSINE was 1340 ± 1151 days, and 4 (5%) patients developed recurrence of dSINE. Morphological analysis between patients after TEVAR with and without dSINE showed a smaller true lumen diameter, a more accentuated oval true lumen morphology, and a higher degree of stent graft oversizing in patients who developed dSINE. CONCLUSIONS: dSINE after TEVAR or FET is not rare and occurs with similar incidence after acute and chronic aortic dissection (early and late). Avoiding oversizing in the acute and chronic settings as well as carefully selecting patients for TEVAR in postdissection aneurysmal formation will aid in reducing the incidence of dSINE to a minimum.
Authors: Tim Berger; Miriam Graap; Bartosz Rylski; Albi Fagu; Roman Gottardi; Tim Walter; Philipp Discher; Muhammad Taha Hagar; Stoyan Kondov; Martin Czerny; Maximilian Kreibich Journal: Front Cardiovasc Med Date: 2022-06-06