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Relevance of Aortic Dissection Chronicity to the Development of Stent Graft-induced New Entry

Takafumi Ouchi1, Noriyuki Kato1, Hiroaki Kato1

  • 1Department of Radiology, Mie University Hospital, Tsu, Japan.

The Annals of Thoracic Surgery
|June 2, 2020
PubMed

Insights

Performing thoracic endovascular aortic repair (TEVAR) early in the chronic phase of aortic dissection can help prevent stent graft-induced new entry (SINE). Lifelong follow-up is crucial for patients treated later, as SINE can occur years after TEVAR.

Area of Science:

  • Cardiovascular Surgery
  • Medical Devices
  • Aortic Diseases

Background:

  • The relationship between aortic dissection chronicity and stent graft-induced new entry (SINE) after thoracic endovascular aortic repair (TEVAR) is not well understood.
  • Chronic aortic dissection management often involves TEVAR, but complication risks related to disease timing require investigation.

Purpose of the Study:

  • To investigate the impact of TEVAR timing relative to aortic dissection chronicity on the incidence and timing of SINE.
  • To identify predictors of SINE development in patients with chronic aortic dissection undergoing TEVAR.

Main Methods:

  • Retrospective review of 69 patients with chronic aortic dissection who underwent TEVAR.
  • Stratification of patients into early (≤6 months) and late (>6 months) TEVAR groups based on disease onset.
  • Comparison of SINE incidence and time to SINE development between the two groups, with multivariate analysis.

Main Results:

  • SINE occurred significantly more often in the late TEVAR group (35%) compared to the early group (12%) (P = .029).
  • The median interval to SINE development was substantially longer in the late group (1144 days) versus the early group (92 days) (P = .002).
  • Late TEVAR timing (hazard ratio, 3.667) and distal oversizing ratio (hazard ratio, 1.492) were independent predictors of SINE.

Conclusions:

  • TEVAR for chronic aortic dissection is best performed early to minimize SINE risk.
  • Patients undergoing TEVAR more than 6 months after dissection onset require vigilant, lifelong surveillance due to the potential for late SINE development.
Abstract

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