Introduction:
Total Arch Replacement (TAR) using a Frozen Elephant Trunk (FET) is performed for chronic type B aortic dissection, with reported successful thrombosis of the false lumen. However, when distal stent graft-induced new entry (dSINE) occurs in the postoperative period, the blood flow within the false lumen remains unclear. In this study, 4D flow MRI was employed for blood flow evaluation in dSINE cases, providing actual measurements of flow velocity and direction, unlike contrast-enhanced CT simulations. Accelerated flow from the true lumen to the false lumen was confirmed, along with an increase in WSS within the false lumen, predicting future enlargement. Consequently, TEVAR was performed for dSINE, resulting in favorable rethrombosis of the false lumen.