Background: Distal stent graft-induced new entry (d-SINE) following total arch replacement using a frozen elephant trunk (TAR FET) or following thoracic endovascular aortic repair (TEVAR) for chronic type B aortic dissection (cTBAD) has been previously reported. Risk factors for d-SINE include oversizing ratio, and stent graft (SG) peripheral angle. We compared the risk factors of d-SINE in cTBAD patients in the TAR FET and TEVAR groups.

Methods: Patients who underwent TAR FET with Frozenix or TEVAR for cTBAD between December 2012 and March 2021 were included. There were eight patients in the TAR FET group (mean age, 61 years) and 15 in the TEVAR group (mean age, 66 years).

Results: d-SINE was occurred on six patients from the TAR FET group and three from the TEVAR group (75.0% vs. 26.3%, p=0.074). The oversizing ratio did not differ significantly between the TAR FET and TEVAR groups (118% vs. 126%, p=0.331). The peripheral angle of the SG was significantly increased (p=0.047) in the TAR FET group (30°) as compared to the TEVAR group (18°). As compared to the TEVAR group, the SG diameter was also considerably smaller in the TAR FET group (26 mm vs. 31 mm, p=0.007), and the SG length was significantly shorter in the TAR FET group (86 mm vs. 140 mm, p=0.023).

Conclusion: Careful planning and appropriate intervention with TEVAR are necessary when performing TAR FET with Frozenix for the management of cTBAD.

Keywords: Distal stent graft-induced new entry, total arch replacement using a frozen elephant trunk, thoracic endovascular aortic repair, chronic type B aortic dissection.