Relevance of Aortic Dissection Chronicity to the Development of Stent Graft-induced New Entry.
Aged
Aortic Dissection
/ complications
Aortic Aneurysm, Thoracic
/ complications
Blood Vessel Prosthesis
/ adverse effects
Blood Vessel Prosthesis Implantation
/ adverse effects
Chronic Disease
Endovascular Procedures
/ adverse effects
Female
Humans
Male
Middle Aged
Postoperative Complications
/ epidemiology
Prosthesis Design
Retrospective Studies
Stents
/ adverse effects
Time Factors
Journal
The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
27
12
2019
revised:
24
03
2020
accepted:
03
04
2020
pubmed:
2
6
2020
medline:
30
12
2020
entrez:
2
6
2020
Statut:
ppublish
Résumé
The relevance of aortic dissection chronicity to the development of stent graft-induced new entry (SINE) is unknown. This study enrolled 69 patients who underwent thoracic endovascular aortic repair (TEVAR) for chronic aortic dissection from January 2006 to December 2017 and were followed up for ≥6 months. Their medical records were reviewed retrospectively. Patients were stratified according to TEVAR timing into an early group (≤6 months from the onset of aortic dissection) and a late group (>6 months after the onset). The incidence of SINE as well as the interval between TEVAR and the development of SINE was compared between these groups. During the follow-up period, SINE occurred in 12% (3/26) and 35% (15/43) of patients in the early and late groups, respectively (P = .029). The interval between TEVAR and SINE development was significantly longer in the late group than the early group (median, 92 days vs 1144 days, respectively; P = .002). According to the multivariate analysis results, the late group (hazard ratio, 3.667; 95% confidence interval, 1.037-12.968; P = .044) and the distal oversizing ratio (hazard ratio, 1.492; 95% confidence interval, 1.071-2.080; P = .018) were the independent predictors for SINE development. TEVAR should be performed in the early period of the chronic phase to prevent SINE. Close and lifelong follow-up is mandatory for patients who undergo TEVAR >6 months after onset because SINE can develop several years after TEVAR in those patients.
Sections du résumé
BACKGROUND
The relevance of aortic dissection chronicity to the development of stent graft-induced new entry (SINE) is unknown.
METHODS
This study enrolled 69 patients who underwent thoracic endovascular aortic repair (TEVAR) for chronic aortic dissection from January 2006 to December 2017 and were followed up for ≥6 months. Their medical records were reviewed retrospectively. Patients were stratified according to TEVAR timing into an early group (≤6 months from the onset of aortic dissection) and a late group (>6 months after the onset). The incidence of SINE as well as the interval between TEVAR and the development of SINE was compared between these groups.
RESULTS
During the follow-up period, SINE occurred in 12% (3/26) and 35% (15/43) of patients in the early and late groups, respectively (P = .029). The interval between TEVAR and SINE development was significantly longer in the late group than the early group (median, 92 days vs 1144 days, respectively; P = .002). According to the multivariate analysis results, the late group (hazard ratio, 3.667; 95% confidence interval, 1.037-12.968; P = .044) and the distal oversizing ratio (hazard ratio, 1.492; 95% confidence interval, 1.071-2.080; P = .018) were the independent predictors for SINE development.
CONCLUSIONS
TEVAR should be performed in the early period of the chronic phase to prevent SINE. Close and lifelong follow-up is mandatory for patients who undergo TEVAR >6 months after onset because SINE can develop several years after TEVAR in those patients.
Identifiants
pubmed: 32479754
pii: S0003-4975(20)30762-1
doi: 10.1016/j.athoracsur.2020.04.032
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1983-1989Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.