Reintervention for distal stent graft-induced new entry after endovascular repair with a stainless steel-based device in aortic dissection
Reintervention for distal stent graft-induced new entry after endovascular repair with a stainless steel-based device in aortic dissection
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DOI：
10.1016/j.jvs.2012.07.006
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发表时间：
2013-01-01
影响因子：
4.3
通讯作者：
Shih, Chun-Che
中科院分区：
文献类型：
--
作者：
Weng, Shih-Hsien;Weng, Chi-Feng;Shih, Chun-Che
目的：在胸主动脉腔内修复术（TEVAR）治疗主动脉夹层后，越来越多地观察到覆膜支架诱导的新进入（SINE）。我们研究了晚期远端SINE的机制、预防策略、覆膜支架的适当尺寸选择和植入sequence.Methods：从2006年11月至2011年5月，99例主动脉夹层患者在我中心接受了Zenith TX 2覆膜支架（Cook，布卢明顿，印第安纳州）TEVAR。其中，27个远端西内斯被识别。这些患者中有8例患有复杂的远端SINE，需要使用新的远端覆膜支架进行干预，所有患者均入选进行进一步分析。结果：2011年2月至2011年7月，27例远端SINE患者中有8例接受了二次覆膜支架手术。所有患者均得到成功治疗，无任何并发症或死亡。在这些patients中观察到高锥度比（35% +/- 11%）和远端支架水平真腔面积过大（293% +/- 76%）。结论：远端SINE的发生率似乎很高;然而，使用不锈钢支架植入物行主动脉夹层TEVAR后死亡率和并发症发生率也很低。复杂的远端SINE可通过远端覆膜支架植入成功解决。通过真腔面积测量的远端覆膜支架尺寸过大可能是导致远端SINE延迟的重要因素。精确的尺寸选择对于支架远端至关重要，尤其是对于高锥度比夹层病变，其中可考虑首先植入远端小尺寸覆膜支架以防止未来远端SINE。（J Vasc Surg 2013;57：64-71.）
Objective: Stent graft-induced new entry (SINE) has been increasingly observed after thoracic endovascular aortic repair (TEVAR) for aortic dissection. We investigated the mechanism of late distal SINE, prevention strategies, proper size selection of the stent graft, and implantation sequence.Methods: From November 2006 to May 2011, 99 patients with aortic dissection underwent TEVAR with Zenith TX2 stent grafts (Cook, Bloomington, Ind) at our center. Among them, 27 distal SINEs were recognized. Eight of these patients with complicated distal SINE required intervention with new distal endografts, and all were enrolled for further analysis.Results: Eight of the 27 patients with distal SINE underwent a secondary endograft procedure from February 2011 to July 2011. All were successfully treated without any complications or deaths. A high taper ratio (35% +/- 11%) and excessive oversizing of the true lumen area at the distal stent level (293% +/- 76%) were noted among these patients.Conclusions: The incidence of distal SINE seemed to be high; however, there were also low rates of death and complications after TEVAR for aortic dissection using stainless steel-based stent grafts. Complicated distal SINE can successfully be resolved by distal endograft implantation. Excessive oversizing of the distal stent graft, as measured by the true lumen area, may be a significant factor causing delayed distal SINE. Precise size selection is crucial for the distal end of the stent, especially for high taper ratio dissection pathology in which the implantation sequence of a distal small-sized stent graft first might be considered to prevent future distal SINE. (J Vasc Surg 2013;57:64-71.)