• Chun-Yang Huang, Chih-Wen Chen, Po-Lin Chen, Wei-Yuan Chen, I-Ming Chen, Chiao-Po Hsu, and Chun-Che Shih.
• Division of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.
• Ann Vasc Surg. 2016 Feb 1; 31: 60-9.

BackgroundThis study evaluated sequential aortic morphologic remodeling and influencing factors between distal stent graft-induced new entry (SINE) in chronic residual type A dissecting aortic aneurysm after extensive hybrid arch repair.MethodsWe retrospectively analyzed operative and follow-up data of 30 consecutive patients with chronic residual type A aortic dissection aneurysm treated by hybrid type III arch repair (ascending aortic and arch replacement combined with elephant trunk technique before stent-graft deployment) between November 2006 and October 2011.ResultsIn 3 years, follow-up of 24 patients with successful 1-stage hybrid arch repair and stent grafting. The ratio of true lumen area increased at pulmonary artery level, but minimal change was seen in the thoracic segment distal to stent graft and abdominal aorta. Late distal SINE occurred in 14 patients (SINE group). Cross-sectional area showed significant differences in distal end of pre-stenting graft oversizing ratio (SINE group 4.32 vs. non-SINE group 2.23, P = 0.021(∗)). The thoracic segment thrombosis rate was 90% in SINE and 57% in non-SINE (P = 0.089) groups.ConclusionsIn homogenous population of chronic residual type A dissection, noticeable false lumen thrombosis with true lumen progressive dilatation was only found at the proximal descending aortic segment extending to the middle of stent grafts in both groups. A smaller size selection of the distal stent graft by area measurement would be accompanied with poor aortic remodeling but might be beneficial for SINE prevention. On the other hand, a larger size selection of the distal stent graft area might be favorable for aortic remodeling but could potentially induce SINE.Copyright © 2016 Elsevier Inc. All rights reserved.

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