Factors predictive of distal stent graft-induced new entry after hybrid arch elephant trunk repair with stainless steel–based device in aortic dissection
| Autor: | Chiao-Po Hsu, Wei-Yuan Chen, Chun-Che Shih, Chi-Feng Weng, I-Ming Chen, Chun-Yang Huang, Shih-Hsien Weng |
|---|---|
| Jazyk: | angličtina |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Time Factors Elephant trunks medicine.medical_treatment Lumen (anatomy) Aorta Thoracic Prosthesis Design Aortography Blood Vessel Prosthesis Implantation Postoperative Complications Risk Factors medicine.artery medicine Humans Arch Aged Aortic dissection Aorta Chi-Square Distribution Aortic Aneurysm Thoracic business.industry Endovascular Procedures Stent Middle Aged Stainless Steel Circumference medicine.disease Blood Vessel Prosthesis Surgery Predictive factor Aortic Dissection Treatment Outcome Female Stents Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. (3):623-630 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2012.07.052 |
| Popis: | Objectives Stent graft-induced new entry (SINE) has been increasingly observed after thoracic endovascular aortic repair of aortic dissection. We illustrate the possible mechanism by exploring predictive factors of late distal SINE after hybrid arch elephant trunk repair for aortic dissection. Methods From November 2006, to May 2011, 20 of 99 patients underwent hybrid arch repair using the elephant trunk graft as the proximal landing zone. After a mean follow-up period of 27.9 ± 12.0 months, 12 patients had late distal SINE events and the others were free of events. False lumen remodeling level was observed and maximal longitudinal diameter, average of longitudinal and transverse maximal diameter, circumference, and area of true lumen were analyzed for precise size selection of stent graft before and after the procedure. Taper ratio, true lumen:aorta ratio, prestent grafting oversizing ratio, poststent grafting oversizing ratio, and expansion mismatch ratio of distal true lumen were proposed and calculated for further evaluation of the mechanism of late distal SINE. Results Only the area oversizing ratio between true lumen and the distal selected stent graft at the presumed distal end of stent grafting was found as a significant predictive factor of SINE before procedure (4.00 ± 2.96 vs 1.98 ± 0.66 for SINE vs non-SINE, respectively; P = .031). The significant difference of the expansion mismatch ratio of true lumen between the 2 groups was found not only in the size measurement of mean diameter (1.48 ± 0.29 vs 1.22 ± 0.15; P = .039), but also in the area (2.39 ± 0.85 vs 1.58 ± 0.42; P = .031) and circumference (1.43 ± 0.27 vs 1.18 ± 0.14; P = .016) after stent grafting. Conclusions We found that taper ratio is not an optimal criteria for stent graft size selection and distal oversizing calculated by true-lumen area is a significant factor causing delayed distal SINE. Use of the prestenting area oversizing ratio should be limited. |
| Databáze: | OpenAIRE |
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