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<p>Distal stent graft-induced new entry (dSINE) represents a&#xa0;complication after the frozen elephant trunk (FET) procedure. A&#xa0;dSINE leads to negative aortic remodeling and is associated with a&#xa0;high reintervention rate. In this study 512 patients who underwent FET surgery at the University Hospital Essen between 2005 and 2024 were retrospectively analyzed with the aim to investigate the incidence, outcomes and different presentations of dSINE. Of the patients 39 (7.6%) developed a&#xa0;dSINE after an average of 3.0 ± 2.8&#xa0;years. The incidence varied depending on the underlying aortic pathology: 23% in chronic aortic dissections, 5% in acute dissections and 2% in aneurysms. In 37&#xa0;out of 39&#xa0;cases a&#xa0;reintervention was performed, with the majority of patients treated endovascularly (32/39) and 5/39&#xa0;undergoing open surgical repair. Postoperative computed tomography angiography (CTA) was utilized to measure the aortic areas at the landing zone of the stent graft as well as the residual expansion capacity of the stent graft. A&#xa0;new CTA-based classification system was developed, which subdivided dSINE into four types based on different morphological presentations: new intimal tear with formation of a&#xa0;new false lumen (74%), a newly developed type&#xa0;B aortic dissection (5%), an endoleak (13%) and a covered aortic rupture (8%). In summary, the study presents a&#xa0;novel CTA-based classification system for dSINE and highlights its clinical relevance, particularly due to the high reintervention rates and the resulting necessity for close imaging follow-up.</p>

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Klassifizierung und Ergebnisse des „distal stent graft-induced new entry“ nach der Frozen-Elephant-Trunk-Operation

  • 期刊论文

  • 发表日期：

    2025年5月14日

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  • Anja Osswald,
  • Sharaf-Eldin Shehada,
  • Rolf Alexander Jánosi,
  • Matthias Thielmann,
  • Arash Mehdiani,
  • Thomas Schlosser,
  • Payam Akhyari,
  • Konstantinos Tsagakis

摘要

Distal stent graft-induced new entry (dSINE) represents a complication after the frozen elephant trunk (FET) procedure. A dSINE leads to negative aortic remodeling and is associated with a high reintervention rate. In this study 512 patients who underwent FET surgery at the University Hospital Essen between 2005 and 2024 were retrospectively analyzed with the aim to investigate the incidence, outcomes and different presentations of dSINE. Of the patients 39 (7.6%) developed a dSINE after an average of 3.0 ± 2.8 years. The incidence varied depending on the underlying aortic pathology: 23% in chronic aortic dissections, 5% in acute dissections and 2% in aneurysms. In 37 out of 39 cases a reintervention was performed, with the majority of patients treated endovascularly (32/39) and 5/39 undergoing open surgical repair. Postoperative computed tomography angiography (CTA) was utilized to measure the aortic areas at the landing zone of the stent graft as well as the residual expansion capacity of the stent graft. A new CTA-based classification system was developed, which subdivided dSINE into four types based on different morphological presentations: new intimal tear with formation of a new false lumen (74%), a newly developed type B aortic dissection (5%), an endoleak (13%) and a covered aortic rupture (8%). In summary, the study presents a novel CTA-based classification system for dSINE and highlights its clinical relevance, particularly due to the high reintervention rates and the resulting necessity for close imaging follow-up.