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Incidence and risk factors for retrograde type A dissection and stent graft-induced new entry after thoracic endovascular aortic repair.
- Source :
-
Journal of vascular surgery [J Vasc Surg] 2018 Apr; Vol. 67 (4), pp. 1026-1033.e2. Date of Electronic Publication: 2017 Oct 31. - Publication Year :
- 2018
-
Abstract
- Objective: Stent graft (SG)-induced new entry (SINE) and retrograde type A dissection (RTAD) are serious device-related complications occurring after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection (TBAD) and may lead to endograft-related complications including retrograde dissection and death. The purpose of this study was to investigate the incidence and risk factors for the development of RTAD and SINE after TEVAR for TBAD and to identify the complications associated with this.<br />Methods: From April 2005 to October 2013, there were 997 patients who underwent TEVAR for TBAD; 852 were followed up (0-6 years; mean, 2.6 years), and 59 SINEs developed in 53 patients. The oversizing ratio and incidence of RTAD and SINE were compared between proximal bare stent (PBS) and non-PBS groups and RTAD and SINE and non-RTAD and non-SINE groups. The baseline characteristics and SG configurational factors potentially affecting both RTAD and distal SINE were analyzed.<br />Results: There was no significant difference between PBS and non-PBS groups in the incidence of RTAD. A greater oversizing ratio was related to a higher distal SINE rate. SINE was seen more frequently in smokers and in patients with hypertension, Marfan syndrome, and TEVAR in the chronic phase and less frequently in complicated dissection cases. Device-related factors for SINE were SG with a connecting bar and SG length <165 mm. The SG length <165 mm increased the overall proximal and distal SINE incidence in multivariate analysis.<br />Conclusions: The presence of a PBS is not associated with a higher RTAD rate, whereas the use of an SG with a connecting bar and length <165 mm increases the risk of RTAD and SINE after TEVAR.<br /> (Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Aortic Dissection diagnostic imaging
Aorta, Thoracic diagnostic imaging
Aortic Aneurysm, Thoracic diagnostic imaging
Aortography methods
Chi-Square Distribution
China epidemiology
Computed Tomography Angiography
Female
Humans
Incidence
Logistic Models
Male
Metals
Middle Aged
Multivariate Analysis
Prosthesis Design
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Young Adult
Aortic Dissection epidemiology
Aorta, Thoracic surgery
Aortic Aneurysm, Thoracic epidemiology
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation adverse effects
Blood Vessel Prosthesis Implantation instrumentation
Endovascular Procedures adverse effects
Endovascular Procedures instrumentation
Stents
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6809
- Volume :
- 67
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 29097043
- Full Text :
- https://doi.org/10.1016/j.jvs.2017.08.070