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• W1998422020 abstract "Thoracic endovascular aortic repair is a successful treatment strategy for type B aortic dissections, with low morbidity and mortality compared with the gold standard of open repair. Questions still remain regarding its long-term durability and complication rate. There is a growing awareness of new entry tears induced by the stent graft, a potentially lethal complication. We report the case of a 74-year-old woman with a complicated retrograde type A aortic dissection treated with endovascular stent graft coverage. She required open surgical conversion after she developed a symptomatic, new entry tear induced by the stent graft. Thoracic endovascular aortic repair is a successful treatment strategy for type B aortic dissections, with low morbidity and mortality compared with the gold standard of open repair. Questions still remain regarding its long-term durability and complication rate. There is a growing awareness of new entry tears induced by the stent graft, a potentially lethal complication. We report the case of a 74-year-old woman with a complicated retrograde type A aortic dissection treated with endovascular stent graft coverage. She required open surgical conversion after she developed a symptomatic, new entry tear induced by the stent graft. Surgical conversion of failed endografts for thoracic aortic dissection is uncommon. Indications for conversion after endograft deployment include symptomatic recurrent dissection. The treatment of new entry tears or recurrent dissections after endograft repair is not well defined.1Svensson L.G. Kouchoukos N.T. Miller D.C. Bavaria J.E. Coselli J.S. Curi M.A. et al.Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts.Ann Thorac Surg. 2008; 85: S1-S41Abstract Full Text Full Text PDF PubMed Scopus (717) Google Scholar Although endograft coverage of recurrent intimal entry tears in the dissection septum is technically and clinically successful in the short-term, long-term durability and efficacy remains questionable when compared with open repair.2Leurs L.J. Bell R. Degrieck Y. Thomas S. Hobo R. Lundbom J. Endovascular treatment of thoracic aortic diseases: combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries.J Vasc Surg. 2004; 40 (discussion: 679-80): 670-679Abstract Full Text Full Text PDF PubMed Scopus (509) Google Scholar It is unknown whether the cause of a new entry tear after endoluminal stenting of the aorta is due to oversizing of the stent graft, creating unneeded radial force, or if it is a function of an already diseased intima.3Dong Z. Fu W. Wang Y. Wang C. Yan Z. Guo D. et al.Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection.J Vasc Surg. 2010; 52: 1450-1457Abstract Full Text Full Text PDF PubMed Scopus (194) Google Scholar With open surgical techniques, new primary entry tears can be repaired with preservation of the functioning portion of the endograft, with a high success rate and long durability.4Nabi D. Murphy E.H. Pak J. Zarins C.K. Open surgical repair after failed endovascular aneurysm repair: is endograft removal necessary?.J Vasc Surg. 2009; 50: 714-721Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar The choice of an endovascular or open intervention for a new entry tear after an endograft is deployed depends on the location of the dissection and the patient's fitness for surgery. This case report is of a 74-year-old woman with complicated retrograde type A aortic dissection treated with endovascular stent graft coverage that required open surgical conversion after she developed a symptomatic new entry tear induced by the stent graft. Supporting data for endoluminal stent graft and open repair for aortic dissection are reviewed. We also discuss the growing awareness of new entry tear as a late complication of thoracic endovascular aortic repair (TEVAR) and the possible mechanisms underlying it. Our patient is a 74-year-old woman with a history of paroxysmal atrial fibrillation, hyperlipidemia, hypertension, Crohn disease, cholecystectomy, appendectomy, total hip arthroplasty, total abdominal hysterectomy, and abdominal herniorrhaphy who presented to our institution with acute onset, severe, tearing substernal chest pain radiating to her central back. Acute coronary syndrome was ruled out, and computed tomography angiography (CTA) imaging revealed a retrograde type A aortic dissection and a distal thoracic aneurysm (maximum diameter, 5.1 cm) that tapered quickly to normal caliber in the supraceliac aorta. CTA and an intraoperative transesophageal echocardiogram (TEE) showed the entry tear of the dissection was just proximal to the neck of the aneurysm in the distal descending thoracic aorta, and the dissection extended retrograde into the ascending aorta, with a mostly thrombosed false lumen. Clinically, she showed no signs of malperfusion but was in distress from the severe pain that was unresponsive to aggressive blood pressure and pain control. Because of severe refractory pain and concern for impending rupture, she was taken to the operating room urgently for endovascular repair. A spinal drain was placed as a protective adjunct. She underwent endovascular repair of the thoracic aneurysm and dissection with imaging provided by using aortography, TEE, and intravascular ultrasound (IVUS) scans. TEE and IVUS scans revealed a symmetric proximal aortic landing zone diameter of 30 mm and distal aortic diameters of 29 mm. One visible entry tear of the intima was located in the distal one-third of the descending thoracic aorta on the border of the neck of the aneurysm, with contrast extending retrograde in a mostly thrombosed false lumen to approximately the midthoracic aorta (Fig 1, A). No further re-entry tears were noted. The aortic wall seemed thicker than normal due to what appeared to be thrombosed false lumen extending retrograde to the ascending aorta. After discussion with our cardiovascular surgery colleagues regarding ascending and arch repair vs endograft coverage of the entry tear and aneurysm, we decided to proceed with the later. After placement of a 34- × 152-mm TX2 Zenith stent (Cook, Bloomington, Ind), no further tear was noted, and the aneurysm was excluded, without endoleak (Fig 1, B). The celiac and superior mesenteric arteries were patent. Postdeployment balloon dilation was not used. The patient tolerated the procedure well, recovered without complications or spinal ischemia, and was discharged home. CTA at the 1-month interval follow-up showed complete exclusion of the aortic entry tear and aneurysm, without endoleak or graft migration. It also showed a normally appearing ascending and proximal descending thoracic aorta without residual false lumen or new tears. The patient returned 3 months after the TEVAR with severe tearing substernal chest pain radiating to her central back, akin to the symptoms she experienced when she initially presented. CTA showed a new type B aortic dissection with an entry tear beginning at the proximal landing site of the endograft and dissecting retrograde to the level of the left subclavian artery (Fig 2). Clinically, she showed no signs of cardiac, neurologic, or visceral malperfusion. A short trial of nonoperative management was attempted but failed due to refractory pain. Repeat CT showed worsening false lumen enlargement. The etiology of the new entry tear was felt to be due to erosion of the proximal endograft on an abnormal and diseased intima overlying a thrombosed false lumen. Endograft extension would have placed her at a high risk for recurrence, and the decision was made to proceed with open conversion. We performed a posterolateral thoracotomy for replacement of the descending thoracic aorta with a 26-mm Hemashield (Boston Scientific Corp, Natick, Mass) woven tube graft, with perioperative TEE, spinal drainage, and distal aortic perfusion. After achieving cardiopulmonary bypass with distal aortic perfusion and cross-clamping of the aorta, an aortotomy was made in preparation for the anastomoses. When the lumen of the aorta was assessed, a new entry tear was noted at the junction of the interface between the endoluminal stent and aortic intima. The tear ran transversely along the proximal edge of the endograft, extending a quarter of the circumference of the lumen. Teflon felt strips (DuPont, Wilmington, Del) were used to reinforce the aorta proximally and distally using a sandwich technique, with the distal anastomosis sewn to the endograft between Teflon felt strips (Fig 3). The procedure was well tolerated and without complications. Postoperatively, the patient's symptoms resolved, and she showed no signs of malperfusion or spinal ischemia. She was discharged on postoperative day 8 in excellent condition. Postoperative follow-up imaging at 1 and 6 months showed a good surgical outcome. Our patient initially presented with acute aortic syndrome. The diagnosis of a retrograde type A dissection was made by TEE, angiography, IVUS scanning, and CTA, which showed one visible entry tear and a classic dissection flap with organized thrombus within the false lumen. Follow-up imaging after endograft exclusion of the entry tear and the aneurysm showed resolution of the dissection and false lumen. The management of acute type A retrograde dissections with intimal tears in the descending aorta is controversial and has historically included open ascending or arch replacement, or both. Open repair still retains the entry tear of the dissection in the descending thoracic aorta, which does not ameliorate the risk of rupture of the false lumen.1Svensson L.G. Kouchoukos N.T. Miller D.C. Bavaria J.E. Coselli J.S. Curi M.A. et al.Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts.Ann Thorac Surg. 2008; 85: S1-S41Abstract Full Text Full Text PDF PubMed Scopus (717) Google Scholar Our early clinical success with apparent healing of the type A dissection coincides with published series advocating simple endograft coverage of the entry tear even in retrograde type A dissections if valvular, coronary, cardiac, cerebrovascular, or malperfusion complications are absent.1Svensson L.G. Kouchoukos N.T. Miller D.C. Bavaria J.E. Coselli J.S. Curi M.A. et al.Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts.Ann Thorac Surg. 2008; 85: S1-S41Abstract Full Text Full Text PDF PubMed Scopus (717) Google Scholar Some suggest that retrograde type A dissections with uncomplicated involvement of the ascending aorta or arch structures, or with a thrombosed false lumen, should be treated like a type B dissection when the entry tear is located in the descending aorta. When the entry tear is covered, thrombus forms in the false lumen and the dissection can heal. Complicated aortic dissection is responsible for significant morbidity and mortality,5Hagan P.G. Nienaber C.A. Isselbacher E.M. Bruckman D. Karavite D.J. Russman P.L. et al.The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease.JAMA. 2000; 283: 897-903Crossref PubMed Scopus (2671) Google Scholar and >60% of deaths from aortic dissection are due to local rupture, usually of the false lumen.6Miller D.C. Surgical management of aortic dissections: indications, perioperative management, and long-term results.in: Doroghazi R.M. Slater E.E. Aortic dissection. McGraw-Hill, New York1983: 193-243Google Scholar The first report of successful endograft coverage of thoracic aortic dissections was by Dake et al7Dake M.D. Kato N. Mitchell R.S. Semba C.P. Razavi M.K. Shimono T. et al.Endovascular stent-graft placement for the treatment of acute aortic dissection.N Engl J Med. 1999; 340: 1546-1552Crossref PubMed Scopus (1107) Google Scholar in 1999. Since then, with evolution of device design and growing technical experience, TEVAR has increasingly been used, in an off-label manner, as the first-line treatment for thoracic aortic pathologies other than aneurysm. Considered the gold standard for complicated type B aortic dissection, open surgical repair consists of a limited replacement of the aorta at the entry tear, obliterating the dissection with a circumferential reapposition of the dissected septum of the aortic wall at the graft anastomosis. Regardless of protective adjuncts used (ie, distal aortic perfusion or cerebrospinal fluid drainage, or both), open surgical repair carries with it a significant complication and mortality rate.1Svensson L.G. Kouchoukos N.T. Miller D.C. Bavaria J.E. Coselli J.S. Curi M.A. et al.Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts.Ann Thorac Surg. 2008; 85: S1-S41Abstract Full Text Full Text PDF PubMed Scopus (717) Google Scholar, 6Miller D.C. Surgical management of aortic dissections: indications, perioperative management, and long-term results.in: Doroghazi R.M. Slater E.E. Aortic dissection. McGraw-Hill, New York1983: 193-243Google Scholar, 8Sachs T. Pomposelli F. Hagberg R. Hamdan A. Wyers M. Giles K. et al.Open and endovascular repair of type B aortic dissection in the Nationwide Inpatient Sample.J Vasc Surg. 2010; 52 (discussion: 866): 860-866Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar, 9Estrera A.L. Miller 3rd, C.C. Chen E.P. Meada R. Torres R.H. Porat E.E. et al.Descending thoracic aortic aneurysm repair: 12-year experience using distal aortic perfusion and cerebrospinal fluid drainage.Ann Thorac Surg. 2005; 80 (discussion: 1296): 1290-1296Abstract Full Text Full Text PDF PubMed Scopus (177) Google Scholar The rational for open surgical repair and TEVAR are the same: exclude flow through the initial entry tear of the intima into the false lumen. We initially chose to treat this older, frail, and comorbid female patient with TEVAR to obviate the high risk of open surgery. Despite questions regarding long-term durability, perioperative morbidity and mortality is significantly reduced when TEVAR is used. Despite reasonably low early operative morbidity and mortality, late complications requiring reintervention are more common with TEVAR, in this patient a new entry tear induced by the endograft that required open surgical conversion.1Svensson L.G. Kouchoukos N.T. Miller D.C. Bavaria J.E. Coselli J.S. Curi M.A. et al.Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts.Ann Thorac Surg. 2008; 85: S1-S41Abstract Full Text Full Text PDF PubMed Scopus (717) Google Scholar, 2Leurs L.J. Bell R. Degrieck Y. Thomas S. Hobo R. Lundbom J. Endovascular treatment of thoracic aortic diseases: combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries.J Vasc Surg. 2004; 40 (discussion: 679-80): 670-679Abstract Full Text Full Text PDF PubMed Scopus (509) Google Scholar, 8Sachs T. Pomposelli F. Hagberg R. Hamdan A. Wyers M. Giles K. et al.Open and endovascular repair of type B aortic dissection in the Nationwide Inpatient Sample.J Vasc Surg. 2010; 52 (discussion: 866): 860-866Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar, 10Eggebrecht H. Nienaber C.A. Neuhauser M. Baumgart D. Kische S. Schmermund A. et al.Endovascular stent-graft placement in aortic dissection: a meta-analysis.Eur Heart J. 2006; 27: 489-498Crossref PubMed Scopus (456) Google Scholar The contemporary results of open surgery, the gold standard repair of complicated thoracic aortic dissection, show long-term durability with acceptable outcomes in experienced hands. Estrera et al9Estrera A.L. Miller 3rd, C.C. Chen E.P. Meada R. Torres R.H. Porat E.E. et al.Descending thoracic aortic aneurysm repair: 12-year experience using distal aortic perfusion and cerebrospinal fluid drainage.Ann Thorac Surg. 2005; 80 (discussion: 1296): 1290-1296Abstract Full Text Full Text PDF PubMed Scopus (177) Google Scholar reported 300 patients who underwent open repairs of the descending thoracic aorta for various pathologies between February 1991 and September 2004. Adjunct distal aortic perfusion and cerebrospinal fluid drainage were both used in 238 patients (79%), compared with 62 (21%) who underwent simple aortic clamping, with or without an adjunct. Overall, stroke rate was 2.1% and the renal failure rate 4.2%. Occurrence of neurologic deficit was 1.3% if spinal protection adjuncts were used and 6.5% for the nonadjunct group (P < .02). Overall 30-day mortality was 7.3%. Overall long-term survival estimates were 79%, 76%, 64%, and 35%, respectively, at 1, 2, 5, and 10 years. Freedom from aortic-related reoperation was 96% at 13 years, confirming the long-term durability of open repair, unlike TEVAR, which requires long-term surveillance with a high incidence of reintervention.9Estrera A.L. Miller 3rd, C.C. Chen E.P. Meada R. Torres R.H. Porat E.E. et al.Descending thoracic aortic aneurysm repair: 12-year experience using distal aortic perfusion and cerebrospinal fluid drainage.Ann Thorac Surg. 2005; 80 (discussion: 1296): 1290-1296Abstract Full Text Full Text PDF PubMed Scopus (177) Google Scholar These contemporary results reflect improved preoperative treatment, anesthesia, and postoperative care. We used both spinal protective adjuncts during our open repair, yielding no neurologic complications and a good postoperative outcome. Neurologic events were a critical concern in our patient, who required repair of a large portion of her descending thoracic aorta. The results of TEVAR in the treatment of type B aortic dissection and other disease scenarios have shown encouraging results, including a low incidence of neurologic complications (stroke, paraplegia/paraparesis) and low perioperative mortality. Leurs et al2Leurs L.J. Bell R. Degrieck Y. Thomas S. Hobo R. Lundbom J. Endovascular treatment of thoracic aortic diseases: combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries.J Vasc Surg. 2004; 40 (discussion: 679-80): 670-679Abstract Full Text Full Text PDF PubMed Scopus (509) Google Scholar reported TEVAR results in 443 patients collected in the European Collaborators on Stent-Graft Techniques for AAA and Thoracic Aortic Aneurysm and Dissection Repair (EUROSTAR) Registry and the United Kingdom Thoracic Endograft multicenter registries. Of the 443 patients, 131 underwent endograft placement for type B aortic dissection. The procedural success rate was 86%, with 0.8% experiencing paraplegia, and 3.2% experiencing a periprocedural stroke. Operative mortality was lower in patients treated electively than in those undergoing emergency endografting (6.5% vs 12%; P = .55).2Leurs L.J. Bell R. Degrieck Y. Thomas S. Hobo R. Lundbom J. Endovascular treatment of thoracic aortic diseases: combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries.J Vasc Surg. 2004; 40 (discussion: 679-80): 670-679Abstract Full Text Full Text PDF PubMed Scopus (509) Google Scholar The same EUROSTAR registry showed that 40 patients underwent placement of the Cook Zenith TX2 device, the same device we used in our patient. Technical success was achieved in 82.5% of these patients, with 0% paraplegia. None had a retrograde dissection after endograft placement.2Leurs L.J. Bell R. Degrieck Y. Thomas S. Hobo R. Lundbom J. Endovascular treatment of thoracic aortic diseases: combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries.J Vasc Surg. 2004; 40 (discussion: 679-80): 670-679Abstract Full Text Full Text PDF PubMed Scopus (509) Google Scholar Greenberg et al11Greenberg R.K. O'Neill S. Walker E. Haddad F. Lyden S.P. Svensson L.G. et al.Endovascular repair of thoracic aortic lesions with the Zenith TX1 and TX2 thoracic grafts: intermediate-term results.J Vasc Surg. 2005; 41: 589-596Abstract Full Text Full Text PDF PubMed Scopus (163) Google Scholar reported the largest single series (n = 100) using the Cook Zenith endograft for various aortic pathologies and reported no endograft-induced entry tears or retrograde dissections. In reviewing the 37 patients who underwent TEVAR for type B aortic dissection in the Talent Thoracic Registry study, technical success was 98%, and 0.7% required direct surgical conversion. Stroke occurred in 4% and paraplegia in 1.7%. Significantly, paraplegia and paraparesis were associated with the length of covered aorta >20 cm. To achieve a good seal, we placed a 15-cm endograft in the distal thoracic aorta where vital spinal cord vessels are located, without neurologic complications. Kaplan-Meier survival estimates were 91%, 85%, and 78% at 1, 3, at 5 years, respectively, and estimates of freedom from a second procedure were 92%, 81%, and 70% at these respective time intervals.12Fattori R. Nienaber C.A. Rousseau H. Beregi J.P. Heijmen R. Grabenwöger M. et al.Talent Thoracic Retrospective Registry results of endovascular repair of the thoracic aorta with the Talent Thoracic stent graft: the Talent Thoracic Retrospective registry.J Thorac Cardiovasc Surg. 2006; 132: 332-339Abstract Full Text Full Text PDF PubMed Scopus (257) Google Scholar On the basis of the above data, TEVAR has generally superseded open surgery as the first-line approach based on reduced perioperative morbidity and mortality, despite the higher rates of late complications, including endoleaks, graft migration, stent fractures, and need for reintervention. Despite a low early operative morbidity and mortality rate associated with TEVAR, awareness is now maturing regarding new entry tears induced by the endograft that propagate false lumen expansion, rupture, and retrograde dissection, with the associated potential of aortic valve regurgitation, cerebrovascular ischemia, pericardial tamponade, and obstruction of the coronary arteries; all life-threatening complications.3Dong Z. Fu W. Wang Y. Wang C. Yan Z. Guo D. et al.Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection.J Vasc Surg. 2010; 52: 1450-1457Abstract Full Text Full Text PDF PubMed Scopus (194) Google Scholar, 13Eggebrecht H. Thompson M. Rousseau H. Czerny M. Lonn L. Mehta R.H. et al.Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications.Circulation. 2009; 120: S276-S281Crossref PubMed Scopus (294) Google Scholar, 14Kpodonu J. Preventza O. Ramaiah V.G. Shennib H. Wheatley 3rd, G.H. Rodriquez-Lopez J. et al.Retrograde type A dissection after endovascular stenting of the descending thoracic aorta. Is the risk real?.Eur J Cardiothorac Surg. 2008; 33: 1014-1018Crossref PubMed Scopus (119) Google Scholar, 15Bellos J.K. Petrosyan A. Abdulamit T. Trastour J.C. Bergeron P. Retrograde type A aortic dissections after endovascular stent-graft placement for type B dissection.J Cardiovasc Surg (Torino). 2010; 51: 85-93PubMed Google Scholar, 16Neuhauser B. Greiner A. Jaschke W. Chemelli A. Fraedrich G. Serious complications following endovascular thoracic aortic stent-graft repair for type B dissection.Eur J Cardiothorac Surg. 2008; 33: 58-63Crossref PubMed Scopus (128) Google Scholar In the largest single-center report of this phenomenon, based on TEVAR for type B dissection in 650 patients, the incidence of postprocedure retrograde dissection was 3.38%.3Dong Z. Fu W. Wang Y. Wang C. Yan Z. Guo D. et al.Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection.J Vasc Surg. 2010; 52: 1450-1457Abstract Full Text Full Text PDF PubMed Scopus (194) Google Scholar Reports from the European Registry on Endovascular Aortic Repair Complications (EuREC) estimated an incidence of retrograde dissection induced by the endografts at 1.33%.13Eggebrecht H. Thompson M. Rousseau H. Czerny M. Lonn L. Mehta R.H. et al.Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications.Circulation. 2009; 120: S276-S281Crossref PubMed Scopus (294) Google Scholar EuREC suggests that these dissections present in an acute or delayed manner, with 46% occurring within the first 30 days and 31% occurring >3 months postprocedure. Our patient did not present until 3 months postprocedure. Reported mortality rates range from 20% to 57%3Dong Z. Fu W. Wang Y. Wang C. Yan Z. Guo D. et al.Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection.J Vasc Surg. 2010; 52: 1450-1457Abstract Full Text Full Text PDF PubMed Scopus (194) Google Scholar, 13Eggebrecht H. Thompson M. Rousseau H. Czerny M. Lonn L. Mehta R.H. et al.Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications.Circulation. 2009; 120: S276-S281Crossref PubMed Scopus (294) Google Scholar, 14Kpodonu J. Preventza O. Ramaiah V.G. Shennib H. Wheatley 3rd, G.H. Rodriquez-Lopez J. et al.Retrograde type A dissection after endovascular stenting of the descending thoracic aorta. Is the risk real?.Eur J Cardiothorac Surg. 2008; 33: 1014-1018Crossref PubMed Scopus (119) Google Scholar, 15Bellos J.K. Petrosyan A. Abdulamit T. Trastour J.C. Bergeron P. Retrograde type A aortic dissections after endovascular stent-graft placement for type B dissection.J Cardiovasc Surg (Torino). 2010; 51: 85-93PubMed Google Scholar, 16Neuhauser B. Greiner A. Jaschke W. Chemelli A. Fraedrich G. Serious complications following endovascular thoracic aortic stent-graft repair for type B dissection.Eur J Cardiothorac Surg. 2008; 33: 58-63Crossref PubMed Scopus (128) Google Scholar; the mortality rate was 42% in the large EuREC study.13Eggebrecht H. Thompson M. Rousseau H. Czerny M. Lonn L. Mehta R.H. et al.Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications.Circulation. 2009; 120: S276-S281Crossref PubMed Scopus (294) Google Scholar Dong et al3Dong Z. Fu W. Wang Y. Wang C. Yan Z. Guo D. et al.Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection.J Vasc Surg. 2010; 52: 1450-1457Abstract Full Text Full Text PDF PubMed Scopus (194) Google Scholar coined the term stent graft-induced new entry tear, or SINE tear, in their report of 650 patients who underwent TEVAR for type B aortic dissection. A SINE tear developed in 23 (3.38%) of their patients perioperatively or during follow-up, with six deaths (26%). They suggest a strong association of SINE tears with intrinsic aortic intimal disease or weakness because the incidence of SINE was 33.33% among Marfan patients vs 3.26% among non-Marfan patients (P = .016). They also suggest an association of SINE tears with graft construction, bare metal struts, and radial force of the devices. They argue that SINE tears are more common in TEVAR for dissections than aneurysms, supporting the rationale that the tear may be due to an intrinsic weakness of the intima.3Dong Z. Fu W. Wang Y. Wang C. Yan Z. Guo D. et al.Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection.J Vasc Surg. 2010; 52: 1450-1457Abstract Full Text Full Text PDF PubMed Scopus (194) Google Scholar Bellos et al15Bellos J.K. Petrosyan A. Abdulamit T. Trastour J.C. Bergeron P. Retrograde type A aortic dissections after endovascular stent-graft placement for type B dissection.J Cardiovasc Surg (Torino). 2010; 51: 85-93PubMed Google Scholar proposed risk factors for retrograde dissection after TEVAR for type B dissection, including hypertension, smoking, the presence of a bovine arch, Marfan syndrome, and emergency (as opposed to elective) TEVAR.15Bellos J.K. Petrosyan A. Abdulamit T. Trastour J.C. Bergeron P. Retrograde type A aortic dissections after endovascular stent-graft placement for type B dissection.J Cardiovasc Surg (Torino). 2010; 51: 85-93PubMed Google Scholar The etiology of these new tears, or SINE tears, are likely multifactorial complications related to trauma during the procedure, the radial force of the stent graft devices, particular aortic anatomy (ie, curvature) related to device deployment, false lumen remodeling, intrinsic intimal weakness, or natural progression of the aortic disease. Potential procedural causes include trauma of the aortic wall during manipulation of catheters, wires, and devices. Repeated balloon dilation is often used to facilitate conformance along a curved portion of the vessel, a process that can cause intimal injury and induce SINE tears. Graft oversizing (especially by >20%) has also been implicated as a potential cause of retrograde type A dissection after TEVAR.3Dong Z. Fu W. Wang Y. Wang C. Yan Z. Guo D. et al.Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection.J Vasc Surg. 2010; 52: 1450-1457Abstract Full Text Full Text PDF PubMed Scopus (194) Google Scholar, 13Eggebrecht H. Thompson M. Rousseau H. Czerny M. Lonn L. Mehta R.H. et al.Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications.Circulation. 2009; 120: S276-S281Crossref PubMed Scopus (294) Google Scholar, 14Kpodonu J. Preventza O. Ramaiah V.G. Shennib H. Wheatley 3rd, G.H. Rodriquez-Lopez J. et al.Retrograde type A dissection after endovascular stenting of the descending thoracic aorta. Is the risk real?.Eur J Cardiothorac Surg. 2008; 33: 1014-1018Crossref PubMed Scopus (119) Google Scholar, 15Bellos J.K. Petrosyan A. Abdulamit T. Trastour J.C. Bergeron P. Retrograde type A aortic dissections after endovascular stent-graft placement for type B dissection.J Cardiovasc Surg (Torino). 2010; 51: 85-93PubMed Google Scholar, 16Neuhauser B. Greiner A. Jaschke W. Chemelli A. Fraedrich G. Serious complications following endovascular thoracic aortic stent-graft repair for type B dissection.Eur J Cardiothorac Surg. 2008; 33: 58-63Crossref PubMed Scopus (128) Google Scholar During device deployment, close attention to device and patient selection, avoidance of ballooning and oversizing, and careful manipulation is incumbent upon the surgeon. In our patient, the cause of the new entry tear was likely the deployment of the proximal endograft on diseased intima overlying thrombus within a false lumen. Every effort should be made to place the proximal endograft where the aorta is normal in an attempt to reduce possible complications. We deduce, based on the above data supporting the durability of the gold-standard open surgical repair and risk factors described for SINE tears (with associated high mortality), that open conversion, whenever possible, is a reasonable approach to SINE tears because endograft extension can expose a high risk for recurrence, especially in our patient, who has shown a propensity for dissection." @default.
• W1998422020 created "2016-06-24" @default.
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• W1998422020 date "2013-12-01" @default.
• W1998422020 modified "2023-09-25" @default.
• W1998422020 title "Stent graft-induced new entry tear after endoluminal grafting for aortic dissection repaired with open interposition graft" @default.
• W1998422020 cites W2004077363 @default.
• W1998422020 cites W2011996532 @default.
• W1998422020 cites W2023310527 @default.
• W1998422020 cites W2026312046 @default.
• W1998422020 cites W2052707438 @default.
• W1998422020 cites W2058835323 @default.
• W1998422020 cites W2069605925 @default.
• W1998422020 cites W2116948345 @default.
• W1998422020 cites W2117868959 @default.
• W1998422020 cites W2126048034 @default.
• W1998422020 cites W2159964772 @default.
• W1998422020 cites W2161722088 @default.
• W1998422020 cites W2164825715 @default.
• W1998422020 cites W2332004045 @default.
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