title: Thoracic aortic aneurysm expansion due to late distal stent graft-induced new entry.
abstract: OBJECTIVE
  This study analyzed the mechanism and risk factors of thoracic aortic aneurysm expansion due to late distal stent graft-induced new entry (dSINE).
  
  
  BACKGROUND
  This late complication of thoracic endovascular aneurysm repair (TEVAR) for aortic dissection is under-recognized but potentially life-threatening.
  
  
  METHODS
  In 142 patients who underwent TEVAR with endovascular entry sealing for acute and chronic aortic type B dissection, using commercially available straight (nontapered) stent-grafts, we examined the oversizing rate, the aortic taper ratio, and the need for reintervention.
  
  
  RESULTS
  Nine of 142 patients developed thoracic aortic aneurysm expansion due to dSINE after TEVAR. The median follow-up was 47.5 ± 37.4 months. There was a significant difference in the distal stent-aorta angle between the patients with and without dSINE (149.08 ± 15.09° vs. 166.72 ± 12.47°, P < 0.005). Patients with dSINE showed a significantly higher taper ratio of the true lumen of the aorta (40.9 ± 14.13% vs. 25.36 ± 20.2%, P < 0.05). There was also a significant difference in the oversizing of the stent-graft in the distal landing zone (95.88 ± 49.3% vs. 55.94 ± 36.23%, P < 0.01). All patients with dSINE underwent a secondary endograft procedure without any complications or deaths. In 7 cases we used a custom-made, highly tapered stent-graft.
  
  
  CONCLUSIONS
  Lifelong follow-up of patients is mandatory after TEVAR. A stent-graft with a tapered design should be used in aortic dissection to avoid oversizing and devastating late complications.
authors.affiliation: West-German Heart Center Essen, Department of Cardiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Rolf Alexander
authors.initials: RA
authors.lastname: Jánosi
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsagakis
authors.forename: Markus
authors.initials: M
authors.lastname: Bettin
authors.forename: Philipp
authors.initials: P
authors.lastname: Kahlert
authors.forename: Michael
authors.initials: M
authors.lastname: Horacek
authors.forename: Fadi
authors.initials: F
authors.lastname: Al-Rashid
authors.forename: Thomas
authors.initials: T
authors.lastname: Schlosser
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
authors.forename: Holger
authors.initials: H
authors.lastname: Eggebrecht
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: TEVAR; aortic dissection; oversizing; taper ratio