Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection
Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection
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DOI：
10.1016/j.jvs.2010.05.121
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发表时间：
2010-12-01
影响因子：
4.3
通讯作者：
Chen, Bin
中科院分区：
文献类型：
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作者：
Dong, Zhihui;Fu, Weiguo;Chen, Bin
背景：在本中心对Stanford B型夹层行胸主动脉腔内修复术(TEVAR)后，支架引起的新入路(SINE)越来越多地被观察到，它是指支架移植物引起的新的撕裂，排除了因自然疾病进展或医源性损伤而进行的腔内操作。SINE似乎有明显的生命危险。方法：回顾分析2000年8月至2008年6月650例接受TEVAR治疗B型夹层的患者中22例发生SINE的资料。另一名患者在另一家医院接受TEVAR手术14个月后转诊至本中心。结果：23例患者中发现24例正弦撕裂，其中15例为正弦撕裂，7例为远端正弦撕裂，1例为两端正弦撕裂，6例死亡。发病率和死亡率分别为3.4%和26.1%。两名SINE患者被诊断为马凡综合征，而在651名患者中只有6名马凡患者。16条近端正弦线位于弓的大弯处，导致A型夹层逆行。8个远端正弦出现在被剥离的皮瓣上，5个导致动脉瘤扩大，3个稳定。所有23例患者在初次TEVAR中均放置了跨主动脉弓远端的移植物。马凡组SINE发生率为33.33%，非马凡组为3.26%(P=0.016)。近端和远端正弦信号的死亡率(25%比28.6%，P>；.99)，跨弓和降主动脉直段植入正弦信号的发生率(23/613比0/38，P=.39)，正弦信号和非正弦信号的超大率(13%+/-4.5%比16%+/-6.5%，P=.98)。结论：正弦信号在B型夹层切除术后并不少见，且与死亡率有关。内移植物所产生的压力似乎在其发生中起主导作用。在设计和放置内植骨时，考虑到这种应力诱导的损伤是很重要的。(《花瓶外科杂志》2010；52：1450-8)
Background: Stent graft-induced new entry (SINE), defined as the new tear caused by the stent graft and excluding those arising from natural disease progression or iatrogenic injury from the endovascular manipulation, has been increasingly observed after thoracic endovascular aortic repair (TEVAR) for Stanford type B dissection in our center. SINE appears to be remarkably life threatening. We investigated the incidence, mortality, causes, and preventions of SINE after TEVAR for Stanford type B dissection.Methods: Data for 22 patients with SINE were retrospectively collected and analyzed from 650 patients undergoing TEVAR for type B dissection from August 2000 to June 2008. An additional patient was referred to our center 14 months after TEVAR was performed in another hospital. The potential associations of SINE with Marfan syndrome, location of SINE and endograft placement, and the oversizing rate were analyzed by Fisher exact probability test or t test.Results: We found 24 SINE tears in 23 patients, including SINE at the proximal end of the endograft in 15, at the distal end in 7, and at both ends in 1. Six patients died. SINE incidence and mortality reached 3.4% and 26.1%, respectively. Two SINE patients were diagnosed with Marfan syndrome, whereas there were only 6 Marfan patients among the 651 patients. The 16 proximal SINEs were evidenced at the greater curve of the arch and caused retrograde type A dissection. The eight distal SINEs occurred at the dissected flap, and five caused enlarging aneurysm whereas three remained stable. The endograft was placed across the distal aortic arch during the primary TEVAR in all 23 patients. The incidence of SINE was 33.33% among Marfan patients vs 3.26% among non-Marfan patients (P = .016). There was no significant difference in mortality between proximal and distal SINE (25% vs 28.6%, P > .99), incidence of SINE between endograft placement across the arch and at the straight portion of descending thoracic aorta (23 of 613 vs 0 of 38, P = .39), and the oversizing rate between SINE and non-SINE patients (13% +/- 4.5% vs 16% +/- 6.5%, P = .98).Conclusions: SINE appears not to be rare after TEVAR for type B dissection and is associated with substantial mortality. The stress yielded by the endograft seems to play a predominant role in its occurrence. It is important to take this stress-induced injury into account during both design and placement of the endograft. (J Vase Surg 2010;52:1450-8.)