Key result
Acute aortic dissection was the major predicting factor for the development of distal stent graft induced new entry after TEVAR, associated with a 15.8-fold increased odds.
Why the study?
Distal stent graft induced new entry (dSINE) is a rare complication after TEVAR linked to high re-intervention, but its predicting risk factors and long-term outcomes remained to be analysed.
What are the risk factors for distal stent graft induced new entry (dSINE) in patients undergoing TEVAR for type B aortic dissection?
Cohort (n=185)
No
What are the risk factors for distal stent graft induced new entry (dSINE) in patients undergoing TEVAR for type B aortic dissection?
Odds Ratio: 15.8
Acute aortic dissection, increased distal oversizing, and taper ratio are major risk factors for distal stent graft induced new entry after TEVAR, though long-term prognosis remains good even if re-intervention is required.
Acute dissection and distal oversizing were associated with dSINE after TEVAR; leaves open whether tapered grafts reduce risk in prospective studies.
OBJECTIVES: Distal stent graft induced new entry (dSINE) is a rare complication associated with acute and chronic dissections after thoracic endovascular aortic repair (TEVAR) and is linked to a high re-intervention rate. The potential predicting risk factors for dSINE and long term outcome of patients after re-intervention were analysed. METHODS: This single centre, retrospective study included patients undergoing TEVAR. Multivariable analysis was used to test important interventional parameters such as distal oversizing (dOS), taper ratio (TR), angle between distal stent graft and aorta, acute dissection and stent graft length. Re-intervention characteristics were analysed and further long term follow up after re-intervention were evaluated. RESULTS: One hundred and eighty-five patients were analysed with acute (n = 77) and chronic (n = 108) dissections after TEVAR with an average follow up of 68.9 ± 32.5 months. During follow up, 12 (6.5%) patients developed dSINE after a median of 22.2 ± 20.7 months. Acute dissection was identified as a major predicting factor for dSINE development (15.8 fold increased odds), followed by increased dOS and TR. The re-intervention rate was higher in the dSINE group (83% vs. 20%, p = .001), but results indicated that no further re-intervention was needed and no new endoleak development occurred up to a mean follow up of 60.7 ± 54.8 months. No dSINE was seen in association with tapered stent grafts. CONCLUSIONS: Acute aortic dissection was found to be the major predicting factor for dSINE development, followed by increased dOS and TR. The use of tapered stent grafts might be beneficial for patients with high expected dOS and TR. In the rare case of dSINE occurrence, even when re-intervention is required, the long term prognosis is good.
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Lortz et al. (2019) conducted a cohort in Acute and chronic type B aortic dissections (n=185). Acute aortic dissection vs. Chronic aortic dissection was evaluated on Distal stent graft induced new entry (dSINE) (OR 15.8). Acute aortic dissection was the major predicting factor for the development of distal stent graft induced new entry after TEVAR, associated with a 15.8-fold increased odds.
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