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

Authors
 Hyunsik Jang  ;  Man-Deuk Kim  ;  Gyoung Min Kim  ;  Jong Yun Won  ;  Young-Guk Ko  ;  Donghoon Choi  ;  Hyun-Chul Joo  ;  Do Yun Lee 
Citation
 JOURNAL OF VASCULAR SURGERY, Vol.65(3) : 676-685, 2017 
Journal Title
 JOURNAL OF VASCULAR SURGERY 
ISSN
 0741-5214 
Issue Date
2017
MeSH
Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Aneurysm, Dissecting/diagnostic imaging ; Aneurysm, Dissecting/surgery* ; Aortic Aneurysm, Thoracic/diagnostic imaging ; Aortic Aneurysm, Thoracic/surgery* ; Aortography/methods ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation/adverse effects* ; Blood Vessel Prosthesis Implantation/instrumentation ; Chronic Disease ; Computed Tomography Angiography ; Endovascular Procedures/adverse effects* ; Endovascular Procedures/instrumentation ; Female ; Humans ; Incidence ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications/diagnostic imaging ; Postoperative Complications/epidemiology* ; Proportional Hazards Models ; Prosthesis Design ; Retrospective Studies ; Risk Factors ; Seoul/epidemiology ; Stents ; Time Factors ; Treatment Outcome
Abstract
OBJECTIVE: Stent graft-induced new entry (SINE) has been increasingly observed after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. SINE is often life threatening, and reintervention is required. This study investigated risk factors for SINE after TEVAR. METHODS: From July 2001 to June 2013, we retrospectively analyzed data from 79 patients who underwent TEVAR for Stanford type B aortic dissection. TEVAR was performed in 17 patients ≤2 weeks (acute) after the diagnosis of aortic dissection and in the remaining 62 patients >2 weeks (chronic) after diagnosis. Forty-two of the patients underwent TEVAR with modified stent graft with an "inwardly bent" margin, and the remaining 37 underwent TEVAR with a conventional stent graft. The maximal diameter, minimal diameter, mean diameter, circumference, and area of the true lumen were analyzed. Taper ratio and oversizing ratio were evaluated and compared between the SINE and non-SINE groups, and cutoff values of taper ratio and oversizing ratio for prediction of SINE were determined using receiver-operating characteristic curve analysis. The cumulative incidence of SINE was estimated with the Kaplan-Meier method. The multivariate Cox proportional hazards model was used to identify independent predictive variables for SINE. RESULTS: SINE occurred in 21 patients (26.5%) and occurred more frequently in patients with chronic dissection than in those with acute dissection (32.3% vs 5.9%; P = .032). The Kaplan-Meier curves were significantly different (P = .016) between these groups. The incidence of SINE events was not significantly different between the modified stent group and nonmodified stent group (23.8% vs 36.0%; P = .284). The taper ratio and oversizing ratio by maximal diameter, mean diameter, circumference, and area were significantly higher in the SINE group than in the non-SINE group, and Kaplan-Meier curves were significantly different between groups above and below optimal cutoff value (P < .0005 to .003). According to multivariate analysis, the hazard ratios of chronic aortic dissection were 6.30 (95% confidence interval, 0.83-47.74; P = .075) to 7.80 (95% confidence interval, 1.03-59.07; P = .047). The taper ratio and oversizing ratio calculated by maximal diameter, mean diameter, circumference, and area were independent predictors of the development of SINE. CONCLUSIONS: 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.
Full Text
http://www.sciencedirect.com/science/article/pii/S0741521416312502
DOI
10.1016/j.jvs.2016.09.022
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kim, Gyoung Min(김경민) ORCID logo https://orcid.org/0000-0001-6768-4396
Kim, Man Deuk(김만득) ORCID logo https://orcid.org/0000-0002-3575-5847
Won, Jong Yun(원종윤) ORCID logo https://orcid.org/0000-0002-8237-5628
Lee, Do Yun(이도연)
Joo, Hyun Chel(주현철) ORCID logo https://orcid.org/0000-0002-6842-2942
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/153648
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