Research Paper

Determining factors that influence stent graft size selection in extensive residual type A dissecting aortic aneurysm after Hybrid Arch Repair

Abstract

Objectives

In this study, we evaluate the sequential morphological remodeling of true and false lumens and discuss the factors that influence stent graft size selection in extensive residual type A dissecting aortic aneurysm. We looked into two important aspects, aortic cross section area and thrombosis ability with distal Stent graft-induced new entry (SINE) after hybrid arch repair taking into consideration.

Methods

Between November 2006 and September 2011, 24 patients with residual type A aortic dissection aneurysm involving transverse arch were treated by hybrid type III arch repair (ascending aortic and extended transverse arch replacement before stent graft deployment). CT images were used to evaluate the morphological remodeling of the true and false lumen and occurrence of SINE was recorded.

Results

17 out of all the patients with successful one-stage hybrid arch repair and stent grafting received follow-up for two years, and the incident of SINE had occurred in 10 patents. Cross-section area was the only parameter that showed significant difference in distal end of pre-stenting graft oversizing (Non-SINE 2.09 v.s. SINE 4.76, p = 0.025).

Aortic false lumen remodeling in the first year showed shrinkage tendency for both SINE and non-SINE groups at the Subclavian artery level (figure 5 a). However, at the level of pulmonary artery, such a significant difference was only discovered in the SINE group (p = 0.007)

Conclusion

With larger stent grafts, thrombosis ability tended to be enhanced but occurrence of SINE may also increase. Naturally, we would make the size selection base on balancing of these two important factors. It came to our attention that minimizing SINE outweighs faster thrombosis speed because slower thrombosis speed seems not to pose any noticeable threats to the...