Clinical effect of in situ fenestration and chimney technique in the treatment of aortic dissection involving left common carotid artery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIN Shaoxiong ,  YANG Jiansheng

The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, P.R.China;

Corresponding?author：

YANG Jiansheng, Email: jianson@163.com

Keywords：

Aortic dissection; chimney technique; fenestration; bypass; endovascular repair; treatment

DOI：

10.7507/1007-4848.202004064

Video：

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Objective To investigate the clinical effect of in situ fenestration combined with chimney technique in the treatment of aortic dissection involving left common carotid artery.Methods From January 2012 to June 2019, 53 patients with aortic dissection involving left common carotid artery were selected. There were 21 patients in the test group, including 14 males and 7 females, with an average age of 57.2±11.2 years; there were 32 patients in the control group, including 20 males and 12 females, with an average age of 56.7±12.1 years. In the test group, the left subclavian branch was reconstructed by in situ fenestration and the left common carotid artery was reconstructed by chimney technique. In the control group, the left common carotid artery was reconstructed by hybrid operation. The clinical data of the patients were compared.Results The operation time of the test group was significantly longer than that of the control group (151.8±35.2 min vs. 101.3±29.6 min, P=0.00). The patients in the two groups were followed up for 6-20 months. There was no significant difference in the incidence of pulmonary infection, stroke, steal blood syndrome, false lumen thrombosis or internal leakage between the two groups (P>0.05). The diameters of the distal and proximal ends of the true cavity in the test group increased significantly compared with those in the control group (P<0.05).Conclusion In situ fenestration combined with chimney technique is an effective method for the treatment of aortic dissection involving left common carotid artery, which is worthy of further clinical promotion.

Citation： JIN Shaoxiong, YANG Jiansheng. Clinical effect of in situ fenestration and chimney technique in the treatment of aortic dissection involving left common carotid artery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(9): 1020-1024. doi: 10.7507/1007-4848.202004064 Copy

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2.	邱家偉, 趙銳, 王德, 等. 雜交全主動脈弓修復術治療不同年齡段 Stanford A 型主動脈夾層的臨床療效分析. 中國胸心血管外科臨床雜志, 2020, [Epub ahead of print].
3.	張科, 侯培勇, 李祺熠, 等. 體外轉流聯合多種原位開窗技術在主動脈弓部疾病腔內修復的應用. 中國微創外科雜志, 2019, 19(10): 874-877, 881.
4.	龐樺進, 陳勇, 何曉峰, 等. Amplatzer 血管塞聯合 Interlock 可解脫彈簧圈栓塞治療 B 型主動脈夾層 TEVAR 聯合頸動脈煙囪支架治療術后高流量 Ⅰa 型內漏. 實用醫學雜志, 2019, 35(9): 1496-1499.
5.	陳文, 葉仕高, 張迎春, 等. “雜交”技術治療特殊腹髂主動脈病變的應用觀察. 微創醫學, 2018, 13(4): 37-39.
6.	Maynar M, Rostagno R, Zander T, <italic>et al</italic>. Intimal dehiscence in the abdominal aorta following balloon fenestration for type B dissection. J Endovasc Ther, 2005, 12(1): 103-109.
7.	蔡麗生, 蔡銘智, 陳秋賢, 等. Stanford B 型主動脈夾層 52 例報告. 中國微創外科雜志, 2013, 13(10): 41-44.
8.	Canaud L, Ozdemir BA, Patterson BO, <italic>et al</italic>. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann Surg, 2014, 260(2): 389-395.
9.	Fujiyoshi T, Koizumi N, Nishibe T, <italic>et al</italic>. Direct repair of localized aortic dissection with critical malperfusion of the left main trunk. Ann Thorac Cardiovasc Surg, 2018, 24(6): 320-323.
10.	DeSart K, Scali ST, Feezor RJ, <italic>et al</italic>. Fate of patients with spinal cord ischemia complicating thoracic endovascular aortic repair. J Vasc Surg, 2013, 58(3): 635-642.
11.	Bouassida I, Meyrignac O, Marcheix B, <italic>et al</italic>. Treatment of postoperative distal anastomotic endoleak with the Amplatzer Vascular Plug Ⅱ in chronic aortic arch dissection: A case report. J Thorac Cardiovasc Surg, 2018, 155(1): e7-e10.
12.	Kouchoukos NT, Kulik A, Castner CF, <italic>et al</italic>. Open thoracoabdominal aortic repair for chronic type B dissection. J Thorac Cardiovasc Surg, 2015, 149(2 Suppl): S125-S129.
13.	Bavaria J, Vallabhajosyula P, Moeller P, <italic>et al</italic>. Hybrid approaches in the treatment of aortic arch aneurysms: Postoperative and midterm outcomes. J Thorac Cardiovasc Surg, 2013, 145(3): S85-S90.
14.	丘俊濤, 張良, 羅新錦, 等. 主動脈夾層手術時機對預后的影響. 中華胸心血管外科雜志, 2018, 34(1): 26-31.
15.	寇鐳, 陳忠, 唐小斌, 等. 腹主動脈瘤腔內修復術后Ⅱ型內漏的診斷和治療. 心肺血管病雜志, 2016, 35(11): 875-879.
16.	Preventza O, Aftab M, Coselli JS. Hybrid techniques for complex aortic arch surgery. Tex Heart Inst J, 2013, 40(5): 568-571.
17.	鄭智, 劉賦斌, 潘友民, 等. 個體化開窗策略在主動脈疾病腔內修復術中的應用. 中國醫師雜志, 2015, 17(11): 1686-1689.
18.	Tolenaar JL, van Keulen JW, Trimarchi S, <italic>et al</italic>. The chimney graft, a systematic review. Ann Vasc Surg, 2012, 26(7): 1030-1038.
19.	Nauta FJ, Conti M, Kamman AV, <italic>et al</italic>. Biomechanical changes after thoracic endovascular aortic repair in type B dissection: A systematic review. J Endovasc Ther, 2015, 22(6): 918-933.

1. leischman F, Elsayed RS, Cohen RG, <italic>et al</italic>. Selective aortic arch and root replacement in repair of acute type A aortic dissection. Ann Thorac Surg, 2018, 105(2): 505.
2. 邱家偉, 趙銳, 王德, 等. 雜交全主動脈弓修復術治療不同年齡段 Stanford A 型主動脈夾層的臨床療效分析. 中國胸心血管外科臨床雜志, 2020, [Epub ahead of print].
3. 張科, 侯培勇, 李祺熠, 等. 體外轉流聯合多種原位開窗技術在主動脈弓部疾病腔內修復的應用. 中國微創外科雜志, 2019, 19(10): 874-877, 881.
4. 龐樺進, 陳勇, 何曉峰, 等. Amplatzer 血管塞聯合 Interlock 可解脫彈簧圈栓塞治療 B 型主動脈夾層 TEVAR 聯合頸動脈煙囪支架治療術后高流量 Ⅰa 型內漏. 實用醫學雜志, 2019, 35(9): 1496-1499.
5. 陳文, 葉仕高, 張迎春, 等. “雜交”技術治療特殊腹髂主動脈病變的應用觀察. 微創醫學, 2018, 13(4): 37-39.
6. Maynar M, Rostagno R, Zander T, <italic>et al</italic>. Intimal dehiscence in the abdominal aorta following balloon fenestration for type B dissection. J Endovasc Ther, 2005, 12(1): 103-109.
7. 蔡麗生, 蔡銘智, 陳秋賢, 等. Stanford B 型主動脈夾層 52 例報告. 中國微創外科雜志, 2013, 13(10): 41-44.
8. Canaud L, Ozdemir BA, Patterson BO, <italic>et al</italic>. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann Surg, 2014, 260(2): 389-395.
9. Fujiyoshi T, Koizumi N, Nishibe T, <italic>et al</italic>. Direct repair of localized aortic dissection with critical malperfusion of the left main trunk. Ann Thorac Cardiovasc Surg, 2018, 24(6): 320-323.
10. DeSart K, Scali ST, Feezor RJ, <italic>et al</italic>. Fate of patients with spinal cord ischemia complicating thoracic endovascular aortic repair. J Vasc Surg, 2013, 58(3): 635-642.
11. Bouassida I, Meyrignac O, Marcheix B, <italic>et al</italic>. Treatment of postoperative distal anastomotic endoleak with the Amplatzer Vascular Plug Ⅱ in chronic aortic arch dissection: A case report. J Thorac Cardiovasc Surg, 2018, 155(1): e7-e10.
12. Kouchoukos NT, Kulik A, Castner CF, <italic>et al</italic>. Open thoracoabdominal aortic repair for chronic type B dissection. J Thorac Cardiovasc Surg, 2015, 149(2 Suppl): S125-S129.
13. Bavaria J, Vallabhajosyula P, Moeller P, <italic>et al</italic>. Hybrid approaches in the treatment of aortic arch aneurysms: Postoperative and midterm outcomes. J Thorac Cardiovasc Surg, 2013, 145(3): S85-S90.
14. 丘俊濤, 張良, 羅新錦, 等. 主動脈夾層手術時機對預后的影響. 中華胸心血管外科雜志, 2018, 34(1): 26-31.
15. 寇鐳, 陳忠, 唐小斌, 等. 腹主動脈瘤腔內修復術后Ⅱ型內漏的診斷和治療. 心肺血管病雜志, 2016, 35(11): 875-879.
16. Preventza O, Aftab M, Coselli JS. Hybrid techniques for complex aortic arch surgery. Tex Heart Inst J, 2013, 40(5): 568-571.
17. 鄭智, 劉賦斌, 潘友民, 等. 個體化開窗策略在主動脈疾病腔內修復術中的應用. 中國醫師雜志, 2015, 17(11): 1686-1689.
18. Tolenaar JL, van Keulen JW, Trimarchi S, <italic>et al</italic>. The chimney graft, a systematic review. Ann Vasc Surg, 2012, 26(7): 1030-1038.
19. Nauta FJ, Conti M, Kamman AV, <italic>et al</italic>. Biomechanical changes after thoracic endovascular aortic repair in type B dissection: A systematic review. J Endovasc Ther, 2015, 22(6): 918-933.

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Clinical effect of in situ fenestration and chimney technique in the treatment of aortic dissection involving left common carotid artery

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