Department of Cardiovascular Surgery, University Heart Centre Freiburg, Bad Krozingen, Germany.
Cardioangiological Center Bethanien, Frankfurt, Germany.
Ann Thorac Surg. 2020 Nov;110(5):1494-1500. doi: 10.1016/j.athoracsur.2020.02.079. Epub 2020 Apr 10.
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.
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.
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.
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.
本研究旨在了解胸主动脉腔内修复术（TEVAR）或冷冻象鼻植入术后远端支架移植物诱导新入口（dSINE）的发生率和原因，并制定预防方案。
在一项国际多中心登记处（EuREC [欧洲血管内主动脉修复并发症登记处]）的分析中，我们发现 1430 例胸主动脉夹层 B 型 TEVAR 患者中有 69 例 dSINE 患者，100 例主动脉夹层 B 型冷冻象鼻植入术后有 6 例 dSINE 患者，进行形态学比较。
33 例（44%）患者的基础主动脉病理为急性 B 型主动脉夹层，34 例（45%）患者为亚急性或慢性 B 型主动脉夹层，3 例患者为急性 A 型主动脉夹层，3 例患者为 A 型修复后残留夹层，2 例（3%）患者为急性 B 型壁内血肿。TEVAR 后急性和亚急性或慢性 dSINE 发生率分别为 4.4%和 4.9%。冷冻象鼻植入术后，急性和慢性 dSINE 发生率分别为 5.3%和 6.5%。TEVAR 或 FET 后至 dSINE 诊断的时间间隔为 489±681 天。dSINE 后随访时间为 1340±1151 天，4 例（5%）患者出现 dSINE 复发。TEVAR 后有和无 dSINE 的患者之间的形态学分析显示，发生 dSINE 的患者真腔直径较小，真腔形态更明显椭圆形，支架移植物过度扩张程度更高。
TEVAR 或 FET 后 dSINE 并不少见，在急性和慢性主动脉夹层（早期和晚期）后发生率相似。在急性和慢性情况下避免过度扩张，并仔细选择 TEVAR 患者，有助于将 dSINE 的发生率降至最低。
