Thoracic aortic aneurysm expansion due to late distal stent graft‐induced new entry

Abstract

Lifelong follow-up of patients is mandatory after TEVAR. A stent-graft with a tapered design should be used in aortic dissection to avoid oversizing and devastating late complications.

Implantation sequence modification averts distal stent graft-induced new entry after endovascular repair of Stanford type B aortic dissection

“…A number of studies have found that distal oversizing of the stent, in contrast, is related to distal SINE formation, 8,9,11 results similar to those in our study. Only one study reported similar oversizing in SINE and non-SINE patients, but this study included both distal and proximal SINE in the analysis and so is not comparable to the other studies.…”

“…However, two other reports found the taper ratio was higher in distal SINE than in non-SINE patients. 8,11 A concern when the initial insertion of the stent is distal is that before the endograft has been extended to cover the proximal tear, the pressure may build up in the false lumen and cause rupture or retrograde type A dissection. Our stents were prepared in advance, however, which decreased surgical time, and when a distal stent was used, the stent graft was smaller, so expansion of the true lumen was small.…”

“…17 Excessive oversizing at the distal end may increase the radial force on the adjacent aortic tissue to a degree that gradually induces a tear. 11 The force exerted by spring-back on the outer curvature of the distal end of the stent may form an angle between the distal end of the stent and the aorta and induce a tear.…”

“…[7][8][9][10] It has also been suggested that "spring-back", the tendency of a bent, hard tube to return to its original unbent position, can inflict a stress that causes tears at the proximal or distal end of the endograft. 11 However, whether proximal-first or distal-first insertion in multiple endografting has an influence on distal SINE formation has not yet been investigated. We have noticed in our previous research that patients whose stent graft was inserted from proximal thoracic aorta to distal thoracic aorta seemed to have a high incidence of distal SINE.…”

Validation of intravascular ultrasound for measurement of aortic diameters: Comparison with multi-detector computed tomography

“…Clinicians are most often confronted with difficulties in the exact measurement of aortic diameters in the acute setting of thoracic endovascular aortic repair (TEVAR), particularly in tortuosities and especially that of the aortic arch (6). Here, IVUS can be used as an important intraoperative tool to determine the exact aortic vessel diameter in TEVAR (7,8 of secondary endoleaks, and need for reintervention depend on the exact measurement of landing zones (9)(10)(11)(12), which can be especially difficult in emergency cases where no computed tomography (CT) angiography (CTA) or only CT with poor image quality is available. The objective of the present study was to validate IVUS measurements with CTA measurements in detail in a sufficiently high number of patients, which has not been previously reported.…”