Iida Yasunori, Marushita Yoichi, Motohashi Yuka, Sato Toshio
Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan.
Department of Clinical Engineering, Faculty of Medical Science and Technology, Gunma Paz University, Takasaki, Japan.
Front Cardiovasc Med. 2024 Nov 7;11:1478430. doi: 10.3389/fcvm.2024.1478430. eCollection 2024.
A 46-year-old man suffered from acute type A aortic dissection (TAAD) and underwent total arch replacement using the frozen elephant trunk (FET) procedure. During follow-up, we noted back pain and found distal stent graft-induced new entry (dSINE) at the FET distal part by computed tomography. We performed additional extended thoracic endovascular aortic repair (TEVAR) for this pathology. The time between TAAD repair and TEVAR was 2 months. We investigated this complication by computational fluid dynamics analysis through pre- and post-dSINE. The results showed increased wall shear stress at the narrowed true lumen (TL) site, not at the FET site, indicating that prestenotic hydrodynamic load may affect dSINE occurrence.
一名46岁男性患有急性A型主动脉夹层（TAAD），并接受了使用冰冻象鼻技术（FET）的全弓置换术。在随访期间，我们注意到患者出现背痛，并通过计算机断层扫描在FET远端发现了远端支架移植物引起的新破口（dSINE）。我们针对这一病变进行了额外的胸段主动脉腔内修复术（TEVAR）。TAAD修复与TEVAR之间的时间间隔为2个月。我们通过dSINE前后的计算流体动力学分析对这一并发症进行了研究。结果显示，狭窄真腔（TL）部位而非FET部位的壁面剪应力增加，这表明狭窄前的流体动力负荷可能影响dSINE的发生。
