Risk factors for stent graft-induced new entry after thoracic endovascular aortic repair for Stanford type B aortic dissection

Hyunsik Jang, Man Deuk Kim, Gyoung Min Kim, Jong Yun Won, Young Guk Ko, Donghoon Choi, Hyun Chul Joo, Do Yun Lee

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objective Stent graft-induced new entry (SINE) has been increasingly observed after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. SINE is often life threatening, and reintervention is required. This study investigated risk factors for SINE after TEVAR. Methods From July 2001 to June 2013, we retrospectively analyzed data from 79 patients who underwent TEVAR for Stanford type B aortic dissection. TEVAR was performed in 17 patients ≤2 weeks (acute) after the diagnosis of aortic dissection and in the remaining 62 patients >2 weeks (chronic) after diagnosis. Forty-two of the patients underwent TEVAR with modified stent graft with an “inwardly bent” margin, and the remaining 37 underwent TEVAR with a conventional stent graft. The maximal diameter, minimal diameter, mean diameter, circumference, and area of the true lumen were analyzed. Taper ratio and oversizing ratio were evaluated and compared between the SINE and non-SINE groups, and cutoff values of taper ratio and oversizing ratio for prediction of SINE were determined using receiver-operating characteristic curve analysis. The cumulative incidence of SINE was estimated with the Kaplan-Meier method. The multivariate Cox proportional hazards model was used to identify independent predictive variables for SINE. Results SINE occurred in 21 patients (26.5%) and occurred more frequently in patients with chronic dissection than in those with acute dissection (32.3% vs 5.9%; P =.032). The Kaplan-Meier curves were significantly different (P =.016) between these groups. The incidence of SINE events was not significantly different between the modified stent group and nonmodified stent group (23.8% vs 36.0%; P =.284). The taper ratio and oversizing ratio by maximal diameter, mean diameter, circumference, and area were significantly higher in the SINE group than in the non-SINE group, and Kaplan-Meier curves were significantly different between groups above and below optimal cutoff value (P <.0005 to.003). According to multivariate analysis, the hazard ratios of chronic aortic dissection were 6.30 (95% confidence interval, 0.83-47.74; P =.075) to 7.80 (95% confidence interval, 1.03-59.07; P =.047). The taper ratio and oversizing ratio calculated by maximal diameter, mean diameter, circumference, and area were independent predictors of the development of SINE. Conclusions Distal oversizing of the stent graft was an independent predictor of the development of SINE. Appropriate size selection of stent graft without distal oversizing might reduce the risk of late SINE events.

Original languageEnglish
Pages (from-to)676-685
Number of pages10
JournalJournal of Vascular Surgery
Volume65
Issue number3
DOIs
Publication statusPublished - 2017 Mar 1

Fingerprint

Stents
Dissection
Thorax
Transplants
Confidence Intervals
Incidence
Proportional Hazards Models
ROC Curve

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Jang, Hyunsik ; Kim, Man Deuk ; Kim, Gyoung Min ; Won, Jong Yun ; Ko, Young Guk ; Choi, Donghoon ; Joo, Hyun Chul ; Lee, Do Yun. / Risk factors for stent graft-induced new entry after thoracic endovascular aortic repair for Stanford type B aortic dissection. In: Journal of Vascular Surgery. 2017 ; Vol. 65, No. 3. pp. 676-685.
@article{b030ed434ab54379bf583326a19d978e,
title = "Risk factors for stent graft-induced new entry after thoracic endovascular aortic repair for Stanford type B aortic dissection",
abstract = "Objective Stent graft-induced new entry (SINE) has been increasingly observed after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. SINE is often life threatening, and reintervention is required. This study investigated risk factors for SINE after TEVAR. Methods From July 2001 to June 2013, we retrospectively analyzed data from 79 patients who underwent TEVAR for Stanford type B aortic dissection. TEVAR was performed in 17 patients ≤2 weeks (acute) after the diagnosis of aortic dissection and in the remaining 62 patients >2 weeks (chronic) after diagnosis. Forty-two of the patients underwent TEVAR with modified stent graft with an “inwardly bent” margin, and the remaining 37 underwent TEVAR with a conventional stent graft. The maximal diameter, minimal diameter, mean diameter, circumference, and area of the true lumen were analyzed. Taper ratio and oversizing ratio were evaluated and compared between the SINE and non-SINE groups, and cutoff values of taper ratio and oversizing ratio for prediction of SINE were determined using receiver-operating characteristic curve analysis. The cumulative incidence of SINE was estimated with the Kaplan-Meier method. The multivariate Cox proportional hazards model was used to identify independent predictive variables for SINE. Results SINE occurred in 21 patients (26.5{\%}) and occurred more frequently in patients with chronic dissection than in those with acute dissection (32.3{\%} vs 5.9{\%}; P =.032). The Kaplan-Meier curves were significantly different (P =.016) between these groups. The incidence of SINE events was not significantly different between the modified stent group and nonmodified stent group (23.8{\%} vs 36.0{\%}; P =.284). The taper ratio and oversizing ratio by maximal diameter, mean diameter, circumference, and area were significantly higher in the SINE group than in the non-SINE group, and Kaplan-Meier curves were significantly different between groups above and below optimal cutoff value (P <.0005 to.003). According to multivariate analysis, the hazard ratios of chronic aortic dissection were 6.30 (95{\%} confidence interval, 0.83-47.74; P =.075) to 7.80 (95{\%} confidence interval, 1.03-59.07; P =.047). The taper ratio and oversizing ratio calculated by maximal diameter, mean diameter, circumference, and area were independent predictors of the development of SINE. Conclusions Distal oversizing of the stent graft was an independent predictor of the development of SINE. Appropriate size selection of stent graft without distal oversizing might reduce the risk of late SINE events.",
author = "Hyunsik Jang and Kim, {Man Deuk} and Kim, {Gyoung Min} and Won, {Jong Yun} and Ko, {Young Guk} and Donghoon Choi and Joo, {Hyun Chul} and Lee, {Do Yun}",
year = "2017",
month = "3",
day = "1",
doi = "10.1016/j.jvs.2016.09.022",
language = "English",
volume = "65",
pages = "676--685",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "3",

}

Risk factors for stent graft-induced new entry after thoracic endovascular aortic repair for Stanford type B aortic dissection. / Jang, Hyunsik; Kim, Man Deuk; Kim, Gyoung Min; Won, Jong Yun; Ko, Young Guk; Choi, Donghoon; Joo, Hyun Chul; Lee, Do Yun.

In: Journal of Vascular Surgery, Vol. 65, No. 3, 01.03.2017, p. 676-685.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Risk factors for stent graft-induced new entry after thoracic endovascular aortic repair for Stanford type B aortic dissection

AU - Jang, Hyunsik

AU - Kim, Man Deuk

AU - Kim, Gyoung Min

AU - Won, Jong Yun

AU - Ko, Young Guk

AU - Choi, Donghoon

AU - Joo, Hyun Chul

AU - Lee, Do Yun

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Objective Stent graft-induced new entry (SINE) has been increasingly observed after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. SINE is often life threatening, and reintervention is required. This study investigated risk factors for SINE after TEVAR. Methods From July 2001 to June 2013, we retrospectively analyzed data from 79 patients who underwent TEVAR for Stanford type B aortic dissection. TEVAR was performed in 17 patients ≤2 weeks (acute) after the diagnosis of aortic dissection and in the remaining 62 patients >2 weeks (chronic) after diagnosis. Forty-two of the patients underwent TEVAR with modified stent graft with an “inwardly bent” margin, and the remaining 37 underwent TEVAR with a conventional stent graft. The maximal diameter, minimal diameter, mean diameter, circumference, and area of the true lumen were analyzed. Taper ratio and oversizing ratio were evaluated and compared between the SINE and non-SINE groups, and cutoff values of taper ratio and oversizing ratio for prediction of SINE were determined using receiver-operating characteristic curve analysis. The cumulative incidence of SINE was estimated with the Kaplan-Meier method. The multivariate Cox proportional hazards model was used to identify independent predictive variables for SINE. Results SINE occurred in 21 patients (26.5%) and occurred more frequently in patients with chronic dissection than in those with acute dissection (32.3% vs 5.9%; P =.032). The Kaplan-Meier curves were significantly different (P =.016) between these groups. The incidence of SINE events was not significantly different between the modified stent group and nonmodified stent group (23.8% vs 36.0%; P =.284). The taper ratio and oversizing ratio by maximal diameter, mean diameter, circumference, and area were significantly higher in the SINE group than in the non-SINE group, and Kaplan-Meier curves were significantly different between groups above and below optimal cutoff value (P <.0005 to.003). According to multivariate analysis, the hazard ratios of chronic aortic dissection were 6.30 (95% confidence interval, 0.83-47.74; P =.075) to 7.80 (95% confidence interval, 1.03-59.07; P =.047). The taper ratio and oversizing ratio calculated by maximal diameter, mean diameter, circumference, and area were independent predictors of the development of SINE. Conclusions Distal oversizing of the stent graft was an independent predictor of the development of SINE. Appropriate size selection of stent graft without distal oversizing might reduce the risk of late SINE events.

AB - Objective Stent graft-induced new entry (SINE) has been increasingly observed after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. SINE is often life threatening, and reintervention is required. This study investigated risk factors for SINE after TEVAR. Methods From July 2001 to June 2013, we retrospectively analyzed data from 79 patients who underwent TEVAR for Stanford type B aortic dissection. TEVAR was performed in 17 patients ≤2 weeks (acute) after the diagnosis of aortic dissection and in the remaining 62 patients >2 weeks (chronic) after diagnosis. Forty-two of the patients underwent TEVAR with modified stent graft with an “inwardly bent” margin, and the remaining 37 underwent TEVAR with a conventional stent graft. The maximal diameter, minimal diameter, mean diameter, circumference, and area of the true lumen were analyzed. Taper ratio and oversizing ratio were evaluated and compared between the SINE and non-SINE groups, and cutoff values of taper ratio and oversizing ratio for prediction of SINE were determined using receiver-operating characteristic curve analysis. The cumulative incidence of SINE was estimated with the Kaplan-Meier method. The multivariate Cox proportional hazards model was used to identify independent predictive variables for SINE. Results SINE occurred in 21 patients (26.5%) and occurred more frequently in patients with chronic dissection than in those with acute dissection (32.3% vs 5.9%; P =.032). The Kaplan-Meier curves were significantly different (P =.016) between these groups. The incidence of SINE events was not significantly different between the modified stent group and nonmodified stent group (23.8% vs 36.0%; P =.284). The taper ratio and oversizing ratio by maximal diameter, mean diameter, circumference, and area were significantly higher in the SINE group than in the non-SINE group, and Kaplan-Meier curves were significantly different between groups above and below optimal cutoff value (P <.0005 to.003). According to multivariate analysis, the hazard ratios of chronic aortic dissection were 6.30 (95% confidence interval, 0.83-47.74; P =.075) to 7.80 (95% confidence interval, 1.03-59.07; P =.047). The taper ratio and oversizing ratio calculated by maximal diameter, mean diameter, circumference, and area were independent predictors of the development of SINE. Conclusions Distal oversizing of the stent graft was an independent predictor of the development of SINE. Appropriate size selection of stent graft without distal oversizing might reduce the risk of late SINE events.

UR - http://www.scopus.com/inward/record.url?scp=85014088496&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85014088496&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2016.09.022

DO - 10.1016/j.jvs.2016.09.022

M3 - Article

C2 - 28236916

AN - SCOPUS:85014088496

VL - 65

SP - 676

EP - 685

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 3

ER -