Stent Graft-induced Aortic Wall Injury: Incidence, Risk Factors, and Outcomes.

Area of Science:

• Cardiovascular Surgery
• Interventional Radiology
• Vascular Medicine

Background:

• Stent graft-induced new entry is known in thoracic endovascular aortic repair (TEVAR) for aortic dissection.
• The incidence and risk factors of stent graft-induced aortic wall injury (SAWI) in non-dissection cases are not well-defined.

Purpose of the Study:

• To determine the incidence, risk factors, and outcomes of SAWI following TEVAR.
• To investigate SAWI in both dissection and non-dissection cases.

Main Methods:

• Retrospective review of computed tomography angiograms from 430 patients who underwent TEVAR.
• Analysis of radiographic evidence of SAWI, including endograft-induced dissections.
• Cox proportional hazards modeling to identify risk factors for SAWI.

Main Results:

• SAWI was identified in 9% of patients (38/430) during a median follow-up of 2.3 years.
• SAWI occurred proximally in 42%, distally in 53%, and in both locations in 5% of cases.
• Reintervention was required in 29% of SAWI cases. TEVAR for acute dissection (HR 4.6) and devices with proximal bare springs/barbs (HR 5.3) increased SAWI incidence.

Conclusions:

• The incidence of SAWI after TEVAR is low (9%), but a significant proportion (nearly one-third) necessitates reintervention.
• TEVAR in the setting of acute aortic dissection and the use of specific device designs (proximal bare springs or barbs) are associated with a higher risk of SAWI.