• Shih-Hsien Weng, Chi-Feng Weng, Wei-Yuan Chen, Chun-Yang Huang, I-Ming Chen, Chun-Ku Chen, Chiao-Po Hsu, and Chun-Che Shih.
• Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Institutes of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
• J. Vasc. Surg. 2013 Jan 1;57(1):64-71.

ObjectiveStent graft-induced new entry (SINE) has been increasingly observed after thoracic endovascular aortic repair (TEVAR) for aortic dissection. We investigated the mechanism of late distal SINE, prevention strategies, proper size selection of the stent graft, and implantation sequence.MethodsFrom November 2006 to May 2011, 99 patients with aortic dissection underwent TEVAR with Zenith TX2 stent grafts (Cook, Bloomington, Ind) at our center. Among them, 27 distal SINEs were recognized. Eight of these patients with complicated distal SINE required intervention with new distal endografts, and all were enrolled for further analysis.ResultsEight of the 27 patients with distal SINE underwent a secondary endograft procedure from February 2011 to July 2011. All were successfully treated without any complications or deaths. A high taper ratio (35%±11%) and excessive oversizing of the true lumen area at the distal stent level (293%±76%) were noted among these patients.ConclusionsThe incidence of distal SINE seemed to be high; however, there were also low rates of death and complications after TEVAR for aortic dissection using stainless steel-based stent grafts. Complicated distal SINE can successfully be resolved by distal endograft implantation. Excessive oversizing of the distal stent graft, as measured by the true lumen area, may be a significant factor causing delayed distal SINE. Precise size selection is crucial for the distal end of the stent, especially for high taper ratio dissection pathology in which the implantation sequence of a distal small-sized stent graft first might be considered to prevent future distal SINE.Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

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