Association between Aortic Remodeling and Stent Graft-Induced New Entry in Extensive Residual Type A Dissecting Aortic Aneurysm after Hybrid Arch Repair

Chun Yang Huang, Chih Wen Chen, Po Lin Chen, Wei Yuan Chen, I. Ming Chen, Chiao Po Hsu, Chun Che Shih

Research output: Contribution to journalArticle

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Abstract

Background This study evaluated sequential aortic morphologic remodeling and influencing factors between distal stent graft-induced new entry (SINE) in chronic residual type A dissecting aortic aneurysm after extensive hybrid arch repair. Methods We retrospectively analyzed operative and follow-up data of 30 consecutive patients with chronic residual type A aortic dissection aneurysm treated by hybrid type III arch repair (ascending aortic and arch replacement combined with elephant trunk technique before stent-graft deployment) between November 2006 and October 2011. Results In 3 years, follow-up of 24 patients with successful 1-stage hybrid arch repair and stent grafting. The ratio of true lumen area increased at pulmonary artery level, but minimal change was seen in the thoracic segment distal to stent graft and abdominal aorta. Late distal SINE occurred in 14 patients (SINE group). Cross-sectional area showed significant differences in distal end of pre–stenting graft oversizing ratio (SINE group 4.32 vs. non-SINE group 2.23, P = 0.021). The thoracic segment thrombosis rate was 90% in SINE and 57% in non-SINE (P = 0.089) groups. Conclusions In homogenous population of chronic residual type A dissection, noticeable false lumen thrombosis with true lumen progressive dilatation was only found at the proximal descending aortic segment extending to the middle of stent grafts in both groups. A smaller size selection of the distal stent graft by area measurement would be accompanied with poor aortic remodeling but might be beneficial for SINE prevention. On the other hand, a larger size selection of the distal stent graft area might be favorable for aortic remodeling but could potentially induce SINE.

Original languageEnglish
Pages (from-to)60-69
Number of pages10
JournalAnnals of Vascular Surgery
Volume31
DOIs
Publication statusPublished - Feb 1 2016
Externally publishedYes

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Dissecting Aneurysm
Aortic Aneurysm
Stents
Transplants
Dissection
Thrombosis
Thorax
Abdominal Aorta
Thoracic Aorta

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Association between Aortic Remodeling and Stent Graft-Induced New Entry in Extensive Residual Type A Dissecting Aortic Aneurysm after Hybrid Arch Repair. / Huang, Chun Yang; Chen, Chih Wen; Chen, Po Lin; Chen, Wei Yuan; Chen, I. Ming; Hsu, Chiao Po; Shih, Chun Che.

In: Annals of Vascular Surgery, Vol. 31, 01.02.2016, p. 60-69.

Research output: Contribution to journalArticle

Huang, Chun Yang ; Chen, Chih Wen ; Chen, Po Lin ; Chen, Wei Yuan ; Chen, I. Ming ; Hsu, Chiao Po ; Shih, Chun Che. / Association between Aortic Remodeling and Stent Graft-Induced New Entry in Extensive Residual Type A Dissecting Aortic Aneurysm after Hybrid Arch Repair. In: Annals of Vascular Surgery. 2016 ; Vol. 31. pp. 60-69.
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abstract = "Background This study evaluated sequential aortic morphologic remodeling and influencing factors between distal stent graft-induced new entry (SINE) in chronic residual type A dissecting aortic aneurysm after extensive hybrid arch repair. Methods We retrospectively analyzed operative and follow-up data of 30 consecutive patients with chronic residual type A aortic dissection aneurysm treated by hybrid type III arch repair (ascending aortic and arch replacement combined with elephant trunk technique before stent-graft deployment) between November 2006 and October 2011. Results In 3 years, follow-up of 24 patients with successful 1-stage hybrid arch repair and stent grafting. The ratio of true lumen area increased at pulmonary artery level, but minimal change was seen in the thoracic segment distal to stent graft and abdominal aorta. Late distal SINE occurred in 14 patients (SINE group). Cross-sectional area showed significant differences in distal end of pre–stenting graft oversizing ratio (SINE group 4.32 vs. non-SINE group 2.23, P = 0.021∗). The thoracic segment thrombosis rate was 90{\%} in SINE and 57{\%} in non-SINE (P = 0.089) groups. Conclusions In homogenous population of chronic residual type A dissection, noticeable false lumen thrombosis with true lumen progressive dilatation was only found at the proximal descending aortic segment extending to the middle of stent grafts in both groups. A smaller size selection of the distal stent graft by area measurement would be accompanied with poor aortic remodeling but might be beneficial for SINE prevention. On the other hand, a larger size selection of the distal stent graft area might be favorable for aortic remodeling but could potentially induce SINE.",
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N2 - Background This study evaluated sequential aortic morphologic remodeling and influencing factors between distal stent graft-induced new entry (SINE) in chronic residual type A dissecting aortic aneurysm after extensive hybrid arch repair. Methods We retrospectively analyzed operative and follow-up data of 30 consecutive patients with chronic residual type A aortic dissection aneurysm treated by hybrid type III arch repair (ascending aortic and arch replacement combined with elephant trunk technique before stent-graft deployment) between November 2006 and October 2011. Results In 3 years, follow-up of 24 patients with successful 1-stage hybrid arch repair and stent grafting. The ratio of true lumen area increased at pulmonary artery level, but minimal change was seen in the thoracic segment distal to stent graft and abdominal aorta. Late distal SINE occurred in 14 patients (SINE group). Cross-sectional area showed significant differences in distal end of pre–stenting graft oversizing ratio (SINE group 4.32 vs. non-SINE group 2.23, P = 0.021∗). The thoracic segment thrombosis rate was 90% in SINE and 57% in non-SINE (P = 0.089) groups. Conclusions In homogenous population of chronic residual type A dissection, noticeable false lumen thrombosis with true lumen progressive dilatation was only found at the proximal descending aortic segment extending to the middle of stent grafts in both groups. A smaller size selection of the distal stent graft by area measurement would be accompanied with poor aortic remodeling but might be beneficial for SINE prevention. On the other hand, a larger size selection of the distal stent graft area might be favorable for aortic remodeling but could potentially induce SINE.

AB - Background This study evaluated sequential aortic morphologic remodeling and influencing factors between distal stent graft-induced new entry (SINE) in chronic residual type A dissecting aortic aneurysm after extensive hybrid arch repair. Methods We retrospectively analyzed operative and follow-up data of 30 consecutive patients with chronic residual type A aortic dissection aneurysm treated by hybrid type III arch repair (ascending aortic and arch replacement combined with elephant trunk technique before stent-graft deployment) between November 2006 and October 2011. Results In 3 years, follow-up of 24 patients with successful 1-stage hybrid arch repair and stent grafting. The ratio of true lumen area increased at pulmonary artery level, but minimal change was seen in the thoracic segment distal to stent graft and abdominal aorta. Late distal SINE occurred in 14 patients (SINE group). Cross-sectional area showed significant differences in distal end of pre–stenting graft oversizing ratio (SINE group 4.32 vs. non-SINE group 2.23, P = 0.021∗). The thoracic segment thrombosis rate was 90% in SINE and 57% in non-SINE (P = 0.089) groups. Conclusions In homogenous population of chronic residual type A dissection, noticeable false lumen thrombosis with true lumen progressive dilatation was only found at the proximal descending aortic segment extending to the middle of stent grafts in both groups. A smaller size selection of the distal stent graft by area measurement would be accompanied with poor aortic remodeling but might be beneficial for SINE prevention. On the other hand, a larger size selection of the distal stent graft area might be favorable for aortic remodeling but could potentially induce SINE.

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