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  • Title: Relevance of Aortic Dissection Chronicity to the Development of Stent Graft-induced New Entry.
    Author: Ouchi T, Kato N, Kato H, Higashigawa T, Ito H, Nakajima K, Chino S, Tokui T, Mizumoto T, Sakuma H.
    Journal: Ann Thorac Surg; 2020 Dec; 110(6):1983-1989. PubMed ID: 32479754.
    Abstract:
    BACKGROUND: The relevance of aortic dissection chronicity to the development of stent graft-induced new entry (SINE) is unknown. METHODS: This study enrolled 69 patients who underwent thoracic endovascular aortic repair (TEVAR) for chronic aortic dissection from January 2006 to December 2017 and were followed up for ≥6 months. Their medical records were reviewed retrospectively. Patients were stratified according to TEVAR timing into an early group (≤6 months from the onset of aortic dissection) and a late group (>6 months after the onset). The incidence of SINE as well as the interval between TEVAR and the development of SINE was compared between these groups. RESULTS: During the follow-up period, SINE occurred in 12% (3/26) and 35% (15/43) of patients in the early and late groups, respectively (P = .029). The interval between TEVAR and SINE development was significantly longer in the late group than the early group (median, 92 days vs 1144 days, respectively; P = .002). According to the multivariate analysis results, the late group (hazard ratio, 3.667; 95% confidence interval, 1.037-12.968; P = .044) and the distal oversizing ratio (hazard ratio, 1.492; 95% confidence interval, 1.071-2.080; P = .018) were the independent predictors for SINE development. CONCLUSIONS: TEVAR should be performed in the early period of the chronic phase to prevent SINE. Close and lifelong follow-up is mandatory for patients who undergo TEVAR >6 months after onset because SINE can develop several years after TEVAR in those patients.
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