Stent Graft Induced New Entry after Thoracic Endovascular Aortic Repair——Insight from Biomechanical Injury by Stent Graft_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DONG Zhihui , FU Weiguo , WANG Yuqi , GUO Daqiao , XU Xin , CHEN Bin , JIANG Junhao , YANG Jue , SHI Zhenyu , ZHU Ting , SHI Yun.

Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China;

Corresponding author：

Keywords：

Aortic dissection; Stent graft induced new entry; Endovascular surgery

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ObjectiveTo analyze the causes and preventions of stent graft induced new entry (SINE) after thoracic endovascular aortic repair (TEVAR) for Stanford type B dissection, particularly from the standpoint of biomechanical behavior of stent graft. MethodsSINE was defined as the new tear caused by the stent graft itself, excluding those arising from natural disease progression or any iatrogenic injury from the endovascular manipulation. Twentytwo patients with SINE were retrospectively collected and analyzed out of 650 cases undergoing TEVAR for type B dissection from August 2000 to June 2008 in our center. An additional case included was referred to our center in 14 months after TEVAR performed in another hospital. ResultsTotally, there were 24 SINEs found in 23 cases, including SINE at the proximal end in 15 cases, at the distal end in 7, and at both in 1, and 6 patients died. The incidence was 3.4% ( 22/650) in our hospital, and the mortality was 26.1% (6/23). All 16 proximal SINEs was located at the greater curve of the arch and caused retrograde type A dissection. All 8 distal SINEs occurred at the dissected flap, and 5 of them caused enlarging aneurysm while 3 remained stable. All 23 cases had the endograft placed across the distal aortic arch during the primary TEVAR. ConclusionsSINE is not rare following TEVAR for type B dissection, and associates with a high substantial mortality. The stress yielded by the endograft seems to play a predominant role in its occurrence. It is of significance to take the stressinduced injury into account during both design and placement of the endograft.

Citation： DONG Zhihui,FU Weiguo,WANG Yuqi,GUO Daqiao,XU Xin,CHEN Bin,JIANG Junhao,YANG Jue,SHI Zhenyu,ZHU Ting,SHI Yun.. Stent Graft Induced New Entry after Thoracic Endovascular Aortic Repair——Insight from Biomechanical Injury by Stent Graft. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(10): 1031-1038. doi: Copy

1.	Dong ZH, Fu WG, Wang YQ, et al. Retrograde type a aortic dissection after endovascular stent graft placement for treatment of type B dissection [J]. Circulation, 2009, 119(5): 735741.
2.	Fu WG, Shi Y, Wang YQ, et al. Endovascular therapy for stanford type B aortic dissection in 102 cases [J]. Asian J Surg, 2005, 28(4): 271276.
3.	Fu WG, Dong ZH, Wang YQ, et al. Strategies for managing the insufficiency of the proximal landing zone during endovascular thoracic aortic repair [J]. Chin Med J (Engl), 2005, 118(13): 10661071.
4.	Steingruber IE, Chemelli A, Glodny B, et al. Endovascular repair of acute type B aortic dissection:midterm results [J]. J Endovasc Ther, 2008, 15(2): 150160.
5.	Neuhauser B, Czermak BV, Fish J, et al. Type a dissection following endovascular thoracic aortic stentgraft repair [J]. J Endovasc Ther, 2005, 12(1): 7481.
6.	Kpodonu J, Preventza O, Ramaiah VG, et al. Retrograde type a dissection after endovascular stenting of the descending thoracic aorta. is the risk real? [J]. Eur J Cardiothorac Surg, 2008, 33(6): 10141018.
7.	Fanelli F, Salvatori FM, Marcelli G, et al. Type a aortic dissection developing during endovascular repair of an acute type B dissection [J]. J Endovasc Ther, 2003, 10(2): 254259.

1. Dong ZH, Fu WG, Wang YQ, et al. Retrograde type a aortic dissection after endovascular stent graft placement for treatment of type B dissection [J]. Circulation, 2009, 119(5): 735741.
2. Fu WG, Shi Y, Wang YQ, et al. Endovascular therapy for stanford type B aortic dissection in 102 cases [J]. Asian J Surg, 2005, 28(4): 271276.
3. Fu WG, Dong ZH, Wang YQ, et al. Strategies for managing the insufficiency of the proximal landing zone during endovascular thoracic aortic repair [J]. Chin Med J (Engl), 2005, 118(13): 10661071.
4. Steingruber IE, Chemelli A, Glodny B, et al. Endovascular repair of acute type B aortic dissection:midterm results [J]. J Endovasc Ther, 2008, 15(2): 150160.
5. Neuhauser B, Czermak BV, Fish J, et al. Type a dissection following endovascular thoracic aortic stentgraft repair [J]. J Endovasc Ther, 2005, 12(1): 7481.
6. Kpodonu J, Preventza O, Ramaiah VG, et al. Retrograde type a dissection after endovascular stenting of the descending thoracic aorta. is the risk real? [J]. Eur J Cardiothorac Surg, 2008, 33(6): 10141018.
7. Fanelli F, Salvatori FM, Marcelli G, et al. Type a aortic dissection developing during endovascular repair of an acute type B dissection [J]. J Endovasc Ther, 2003, 10(2): 254259.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Stent Graft Induced New Entry after Thoracic Endovascular Aortic Repair——Insight from Biomechanical Injury by Stent Graft

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