Implantation sequence modification averts distal stent graft-induced new entry after endovascular repair of Stanford type B aortic dissection I-Ming.

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Presentation transcript:

Implantation sequence modification averts distal stent graft-induced new entry after endovascular repair of Stanford type B aortic dissection I-Ming Chen, MD, Chun-Yang Huang, MD, Shih-Hsien Weng, MD, Ping-Yi Lin, MD, Po-Lin Chen, MD, Wei-Yuan Chen, MD, Chun-Che Shih, MD, PhD Journal of Vascular Surgery Volume 64, Issue 2, Pages 281-288 (August 2016) DOI: 10.1016/j.jvs.2016.02.032 Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 1 Postoperative computed tomography (CT) angiography at (A) 1 week, (B) 6 months, and (C) 12 months with first distal stent graft-induced new entry (SINE) detection (arrow). There is a small outpouching at distal edge of stent graft. The posterior margin of the distal stent graft expands outward posteriorly and is not identical to the posterior margin of true lumen. This indicates the very initial stage of distal SINE. D, Postoperative CT at 24 months shows distal SINE (arrow) and growing pseudoaneurysm formation. Journal of Vascular Surgery 2016 64, 281-288DOI: (10.1016/j.jvs.2016.02.032) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 2 A, Xpro is the presumed area for proximal landing. XA is the presumed area for distal landing. B, Longitudinal maximal diameter of XA. C, Longitudinal and transverse maximal diameter of XA. D, Area and circumference of XA. Journal of Vascular Surgery 2016 64, 281-288DOI: (10.1016/j.jvs.2016.02.032) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 3 A, Sagittal view of postoperative computed tomography (CT) shows distal stent graft-induced new entry (SINE). XG’ is the distal size of the stent after the procedure if partially expanded. XA2cm is the size of the true lumen 2 cm distal to the distal end of the stent graft after the procedure. B, Longitudinal maximal diameter of XG’. C, Longitudinal and transverse maximal diameter of XG’. D, Area and circumference of XG’. E, Longitudinal maximal diameter of XA2cm. F, Longitudinal and transverse maximal diameter of XA2cm. G, Area and circumference of XA2cm. The arrow indicates SINE area. Journal of Vascular Surgery 2016 64, 281-288DOI: (10.1016/j.jvs.2016.02.032) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 4 Rate of patients with stent graft-induced new entry (SINE) occurrence by distal-first or proximal-first deployment sequence (N = 73). Data are presented as the rate of patients with or without SINE occurrence given distal-first or proximal-first deployment. The difference between distal-first or proximal-first patients was compared using the Fisher exact test. ∗P < .05 indicates significantly different between distal-first or proximal-first insertion. Journal of Vascular Surgery 2016 64, 281-288DOI: (10.1016/j.jvs.2016.02.032) Copyright © 2016 Society for Vascular Surgery Terms and Conditions