title: Implantation sequence modification averts distal stent graft-induced new entry after endovascular repair of Stanford type B aortic dissection.
abstract: OBJECTIVE
  This study investigated predisposing factors of distal stent graft-induced new entry (SINE).
  
  
  METHODS
  Data from November 2006 to May 2012 were abstracted retrospectively from the records of 73 patients with complicated type B aortic dissection who had received stent graft treatment in our institution. Diameters of the true and false lumen, area and circumference of the true lumen, prestent and poststent oversize, taper, and mismatch ratio were recorded and analyzed to see if there were any significant differences between the SINE (n = 19) and non-SINE (n = 54) population and between those in whom the initial endograft was inserted from the proximal thoracic aorta (n = 49) or the distal thoracic aorta (n = 24).
  
  
  RESULTS
  A distal-first sequence of stent graft deployment produced significantly fewer instances of distal SINE. The area oversizing ratio of the distal end of the stent graft was greater in the SINE vs non-SINE groups (3.76 ± 1.7 vs 2.63 ± 2.57; P = .002) and in the proximal-first vs distal-first deployment sequence groups (3.67 ± 2.57 vs 1.39 ± 0.90; P < .001).
  
  
  CONCLUSIONS
  Minimizing the preprocedure distal oversizing ratio with a distal small graft-first procedure could reduce the risk of late distal SINE for Stanford type B aortic dissection. Furthermore, the area ratio is a potentially more sensitive modality for size assessment and prediction of distal SINE occurrence.
authors.affiliation: Institute of Clinical Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: I-Ming
authors.initials: IM
authors.lastname: Chen
authors.affiliation: Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chun-Yang
authors.initials: CY
authors.lastname: Huang
authors.affiliation: Institute of Clinical Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Shih-Hsien
authors.initials: SH
authors.lastname: Weng
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Ping-Yi
authors.initials: PY
authors.lastname: Lin
authors.affiliation: Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Po-Lin
authors.initials: PL
authors.lastname: Chen
authors.affiliation: Institute of Clinical Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Wei-Yuan
authors.initials: WY
authors.lastname: Chen
authors.affiliation: Institute of Clinical Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: ccshih@vghtpe.gov.tw.
authors.forename: Chun-Che
authors.initials: CC
authors.lastname: Shih
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult