title: Association between Aortic Remodeling and Stent Graft-Induced New Entry in Extensive Residual Type A Dissecting Aortic Aneurysm after Hybrid Arch Repair.
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.
authors.affiliation: Division of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Chun-Yang
authors.initials: CY
authors.lastname: Huang
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Chih-Wen
authors.initials: CW
authors.lastname: Chen
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Po-Lin
authors.initials: PL
authors.lastname: Chen
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Wei-Yuan
authors.initials: WY
authors.lastname: Chen
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: I-Ming
authors.initials: IM
authors.lastname: Chen
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Chiao-Po
authors.initials: CP
authors.lastname: Hsu
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan. Electronic address: ccshih@vghtpe.gov.tw.
authors.forename: Chun-Che
authors.initials: CC
authors.lastname: Shih
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries / 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*; D002908:Chronic Disease; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D066253:Vascular Remodeling; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology*