Risk factors for stent graft-induced new entry after thoracic endovascular aortic repair for Stanford type B aortic dissection

Jang, Hyunsik; Kim, Man Deuk; Kim, Gyoung Min; Won, Jong Yun; Ko, Young Guk; Choi, Donghoon; Joo, Hyun‐Chel; Lee, Do Yun

doi:10.1016/j.jvs.2016.09.022

Cited by 94 publications

(69 citation statements)

References 24 publications

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“…Our previous study indicated that excessive oversizing was potential risk factor of reintervention . It was conceivable that too big oversizing would affect the vascular remodeling of postoperative aorta, resulting in more adverse events such as retrograde type A dissection, stent graft‐induced new entry and distal redissection . Therefore, the oversizing of stent graft for AAD should be recommended and restricted less than 10%, even nearly zero.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of endovascular repair of ascending aortic dissection

Zhang

et al. 2019

Cathet Cardio Intervent

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Background Endovascular repair has been used in selected ascending aortic dissection patients judged unfit for direct open surgery. However, the selective criteria and the results of endovascular repair of ascending aortic dissection, and the potential risk factors of adverse events were still obscure. The aim of this study was to summarize the published data linking endovascular therapy for ascending aortic dissection. Methods Studies reporting endovascular repair of ascending aortic dissections were identified by searching PubMed and Embase databases in accordance with preferred reporting items for systematic reviews and meta‐analyses guidelines, and by reviewing the reference lists of retrieved articles. All available data were pooled and the subgroup analyses were conducted. Results A total of nine studies were identified according to the inclusion criteria. The overall technical success was 91.7%. The mean period of follow‐up was 34.7 months. The early mortality within 30 days and late mortality during the follow‐up were 10.3% and 19.0%, respectively. The incidence of endoleak was 14.3%. In the subgroup analysis, we found that female and oversizing >10% were risk factors of adverse events. Conclusions The pooled results suggested that endovascular repair of ascending aortic dissection was feasible, promising, and inspiring. The selection of endovascular therapy should be cautious based on preoperative evaluation. Application of different strategies for different ascending lesions should be considered. The dedicated endograft for ascending aorta is desperately needed before broader application of endovascular repair for ascending aortic pathologies can be achieved.

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Section: Discussionmentioning

confidence: 99%

Systematic review of endovascular repair of ascending aortic dissection

Zhang

et al. 2019

Cathet Cardio Intervent

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“…Selecting the appropriate size of SG in this pathology is important. An oversized SG might result in formation of a new tear around the edge of the SG,4, 5, 6 and a smaller size of SG can result in type Ia or Ib leakage with treatment failure. Currently, no consensus has been reached as how to decide on the size of an SG in AAD.…”

Section: Discussionmentioning

confidence: 99%

“…In these situations increasing numbers of reports have demonstrated the beneficial effects of stent graft (SG) use in dissected descending aortic lesions 2, 3. However, devastating complications, such as retrograde type A dissection or formation of a new tear around the edge of an SG, have also been reported 4, 5, 6. One of the main factors involved in such disastrous complications is the use of an oversized SG for this pathology 6.…”

Section: Introductionmentioning

confidence: 99%

“…However, devastating complications, such as retrograde type A dissection or formation of a new tear around the edge of an SG, have also been reported 4, 5, 6. One of the main factors involved in such disastrous complications is the use of an oversized SG for this pathology 6. A guide for appropriate selection of the size of an SG is the predissected aortic diameter.…”

Section: Introductionmentioning

confidence: 99%

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Equations for Estimating the Predissected Diameter of the Descending Aorta From Computed Tomographic Images at the Onset of Aortic Dissection

Yamauchi

Masai

Takano

et al. 2018

JAHA

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BackgroundEstimation of the predissected descending aortic diameter is important for deciding on the size of a stent graft in cases of acute aortic dissection. However, no equations for estimating this diameter have been previously reported.Methods and ResultsWe developed and validated new equations by investigating computed tomography images that were scanned within 3 years before dissection and those that were scanned immediately after the onset of dissection. Among 1127 patients with acute aortic dissection (425 type A and 702 type B), 36 were matched for the study from October 2005 to March 2017 at 4 centers. New equations were developed in 17 patients and validated in 19 patients. We measured the predissected whole circumference length (CL) and postdissected whole CL, true lumen CL, the major diameter, and the minor diameter of the acutely dissected aorta, followed by calculation of (post‐trueCL+post‐wholeCL)/2 and (post–major diameter+post—minor diameter)/2. Six equations (linear function) and modified equations were derived from each of the above‐mentioned parameters. In the derivation sets, equations that used the parameter of (post‐trueCL+post‐wholeCL)/2 were strongly correlated with pre‐wholeCL (Y=0.9433x+5.0147; R 2=0.9001) and showed significantly less bias compared with the other 5 equations (P<0.0001). In validation sets using this equation, the mean bias of the circumference length and diameter was 2.7±2.8 and 0.85±0.89 mm, respectively. A total of 99.2% of the calculated values were within 3 mm in diameter or less.ConclusionsOur newly developed equations can be used to calculate the predissected aortic diameter in cases of acute aortic dissection and might help to decide the size of the stent graft.

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“…Excessive distal oversizing has been reported to be an independent predictor of SINE events, which usually require reintervention. It is believed that SINE events occur because of the fragility of the dissected intimal membrane in acute dissection as opposed to chronic dissection [39,40], although SINE events have been reported to be more common in chronic dissection [41]. However, a 2016 study of type B dissection cases reported that a distal-first rather than proximal-first deployment approach resulted in significantly fewer SINE events [42].…”

Section: Introductionmentioning

confidence: 99%

Endovascular Repair in Acute Complicated Type B Aortic Dissection: 3-Year Results from the Valiant US Investigational Device Exemption Study

Lim¹

2017

Korean J Thorac Cardiovasc Surg

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Acute complicated type B aortic dissection (TBAD) is a potentially catastrophic, life-threatening condition. If left untreated, there is a high risk of aortic rupture, irreversible organ or limb damage, or death. Several risk factors have been associated with acute complicated TBAD, including age and refractory hypertension. In the acute phase, even uncomplicated patients are more prone to develop complications if hypertension and pain are left medically untreated. Innovations in stent graft technologies have incrementally improved outcomes since their first use for this condition in 1999, though improvement is needed in mitigating periprocedural complications, adverse events, and mortality. In the past decade, endovascular repair has become the preferred treatment because of its superior outcomes to open repair and medical therapy. The Valiant Captivia Thoracic Stent Graft System is a third-generation endovascular stent graft with advancements in minimally invasive delivery, conformability to the anatomy, and the minimization of adverse sequelae. Herein, this stent graft is briefly reviewed and its 3-year outcomes are presented. Freedom from all-cause and dissection-related mortality was 79.1% and 90.0%, respectively. The Valiant Captivia Stent Graft represents a safe, effective intervention for acute complicated TBAD. Continued surveillance is needed to verify its longer-term durability.

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Risk factors for stent graft-induced new entry after thoracic endovascular aortic repair for Stanford type B aortic dissection

Abstract: Distal oversizing of the stent graft was an independent predictor of the development of SINE. Appropriate size selection of stent graft without distal oversizing might reduce the risk of late SINE events.

Cited by 94 publications

References 24 publications

Systematic review of endovascular repair of ascending aortic dissection

Systematic review of endovascular repair of ascending aortic dissection

Equations for Estimating the Predissected Diameter of the Descending Aorta From Computed Tomographic Images at the Onset of Aortic Dissection

Endovascular Repair in Acute Complicated Type B Aortic Dissection: 3-Year Results from the Valiant US Investigational Device Exemption Study

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