The study sought to learn about incidence and reasons for distal stent graft-induced
new entry (dSINE) after thoracic endovascular aortic repair (TEVAR) or after frozen
elephant trunk (FET) implantation, and develop prevention algorithms.In an analysis
of an international multicenter registry (EuREC [European Registry of Endovascular
Aortic Repair Complications] registry), we found 69 dSINE patients of 1430 (4.8%)
TEVAR patients with type B aortic dissection and 6 dSINE patients of 100 (6%) patients
after the FET procedure for aortic dissection with secondary morphological comparison.The
underlying aortic pathology was acute type B aortic dissection in 33 (44%) patients,
subacute or chronic type B aortic dissection in 34 (45%) patients, acute type A aortic
dissection in 3 patients and remaining dissection after type A repair in 3 (8%) patients,
and acute type B intramural hematoma in 2 (3%) patients. dSINE occurred in 4.4% of
patients in the acute setting and in 4.9% of patients in the subacute or chronic setting
after TEVAR. After the FET procedure, dSINE occurred in 5.3% of patients in the acute
setting and in 6.5% of patients in the chronic setting. The interval between TEVAR
or FET and the diagnosis of dSINE was 489 ± 681 days. Follow-up after dSINE was 1340
± 1151 days, and 4 (5%) patients developed recurrence of dSINE. Morphological analysis
between patients after TEVAR with and without dSINE showed a smaller true lumen diameter,
a more accentuated oval true lumen morphology, and a higher degree of stent graft
oversizing in patients who developed dSINE.dSINE after TEVAR or FET is not rare and
occurs with similar incidence after acute and chronic aortic dissection (early and
late). Avoiding oversizing in the acute and chronic settings as well as carefully
selecting patients for TEVAR in postdissection aneurysmal formation will aid in reducing
the incidence of dSINE to a minimum.
