B型主动脉夹层TEVAR术后远端新发破口：机制、风险因素与干预策略

Distal stent graft-induced new entry after TEVAR for type B aortic dissection: mechanisms, risk factors, and intervention strategies

摘要:

胸主动脉腔内修复术（TEVAR）已成为Stanford B型主动脉夹层（TBAD）的首选治疗方式。然而，支架移植物诱导的远端新发破口（dSINE）作为一种重要的远期并发症，可导致假腔持续灌注、主动脉瘤样扩张甚至破裂，严重影响患者远期预后。近年来，随着TEVAR应用的不断扩大，dSINE的发生机制、危险因素及干预策略逐渐受到关注。本文系统总结了TBAD患者TEVAR术后dSINE的流行病学特征、组织学与生物力学机制、患者及支架相关危险因素，并重点总结了当前预防与治疗策略，包括支架尺寸优化、二次TEVAR及多种新型腔内技术的应用进展，旨在为降低dSINE发生率、优化术后管理及改善患者长期预后提供理论依据与实践指导。

Abstract:

Thoracic endovascular aortic repair (TEVAR) has become the preferred treatment for Stanford type B aortic dissection (TBAD). However, distal stent graft-induced new entry (dSINE) remains a significant long-term complication, which may result in persistent false lumen perfusion, progressive aneurysmal degeneration, and even aortic rupture, thereby adversely affecting long-term outcomes. With the expanding application of TEVAR, increasing attention has been paid to the mechanisms, risk factors, and management strategies of dSINE. This review systematically summarizes the epidemiology, histopathological and biomechanical mechanisms, as well as patient- and device-related risk factors for dSINE following TEVAR in TBAD. Current preventive and therapeutic strategies, including stent sizing optimization, secondary TEVAR, and emerging endovascular techniques, are also discussed, aiming to provide insights for reducing dSINE incidence and improving long-term prognosis.