Clinical effect of <i>in vitro</i> fenestration on reconstruction of left subclavian artery in endovascular treatment of aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Donglin , CHEN Lufeng , LI Rongbin ,  CAI Xudong

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

Corresponding?author：

CAI Xudong, Email: 714889404@qq.com

Keywords：

Aortic dissection; in vitro fenestration; chimney technique; endovascular treatment; left subclavian artery

DOI：

10.7507/1007-4848.202103133

Video：

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Objective To investigate the effect of in vitro fenestration on reconstruction of left subclavian artery in endovascular treatment of aortic dissection.Methods A total of 89 patients with aortic dissection involving left subclavian artery were treated by endovascular treatment in the Second Affiliated Hospital of Fujian Medical University from February 2017 to January 2020. There were 44 patients in the test group, including 36 males and 8 females, with an average age of 58.02±13.58 years. There were 45 patients in the control group, including 35 males and 10 females, with an average age of 54.10±12.32 years. The left subclavian artery was reconstructed by in vitro fenestration in the test group and by chimney technique in the control group. The clinical data were compared between the two groups.Results The operation time of the test group was longer than that of the control group (126.16±7.53 min vs. 96.49±6.52 min, P<0.01). The median follow-up time was 31 (13-48) months. The incidence of endoleak in the test group (4.7%) was lower than that in the control group (18.6%, P=0.04) during the follow-up. There was no statistical difference in the incidence of stroke, myocardial infarction, false lumen thrombosis, retrograde aortic dissection or left subclavian artery occlusion between the two groups (P>0.05).Conclusion In vitro fenestration for reconstructing left subclavian artery in thoracic endovascular aortic repair of aortic dissection is safe and feasible, which is worthy of further clinical promotion.

Citation： LI Donglin, CHEN Lufeng, LI Rongbin, CAI Xudong. Clinical effect of in vitro fenestration on reconstruction of left subclavian artery in endovascular treatment of aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(3): 403-409. doi: 10.7507/1007-4848.202103133 Copy

1.	Lombardi JV, Hughes GC, Appoo JJ, et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg, 2020, 71(3): 723-747.
2.	Mokashi SA, Svensson LG. Guidelines for the management of thoracic aortic disease in 2017. Gen Thorac Cardiovasc Surg, 2019, 67(1): 59-65.
3.	Norton EL, Williams DM, Kim KM, et al. Management of acute type B aortic dissection with malperfusion via endovascular fenestration/stenting. J Thorac Cardiovasc Surg, 2020, 160(5): 1151-1161.
4.	韓嘯, 宋來春, 符竣, 等. 雜交手術治療Stanford B型復雜型主動脈夾層的近中期效果. 中國心血管病研究, 2015, 13(8): 744-746.
5.	Brescia AA, Patel HJ, Likosky DS, et al. Volume-outcome relationships in surgical and endovascular repair of aortic dissection. Ann Thorac Surg, 2019, 108(5): 1299-1306.
6.	周小彪, 宋曼, 郭宏偉, 等. 胸主動脈腔內修復術治療B型主動脈夾層的早中期結果. 中華血管外科雜志, 2020, 5(3): 175-180.
7.	Boufi M, Patterson BO, Loundou AD, et al. Endovascular versus open repair for chronic type B dissection treatment: A meta-analysis. Ann Thorac Surg, 2019, 107(5): 1559-1570.
8.	金少雄, 楊建勝. 原位開窗聯合煙囪技術治療累及左側頸總動脈的主動脈夾層的療效分析. 中國胸心血管外科臨床雜志, 2020, 27(9): 1020-1024.
9.	Tadros RO, Tang GHL, Barnes HJ, et al. Optimal treatment of uncomplicated type B aortic dissection: JACC review topic of the week. J Am Coll Cardiol, 2019, 74(11): 1494-1504.
10.	胡凡果, 朱杰昌, 戴向晨, 等. 體外預開窗腔內修復治療非健康錨定區及短錨定區B型主動脈夾層的前瞻性單中心研究. 中華普通外科雜志, 2020, 35(7): 536-539.
11.	高偉, 劉燊, 丘俊濤, 等. 主動脈弓降部病變患者胸主動脈腔內治療同期左鎖骨下動脈血流重建的近中期效果. 中華胸心血管外科雜志, 2017, 33(10): 587-590.
12.	Liu Z, Zhang Y, Liu C, et al. Treatment of serious complications following endovascular aortic repair for type B thoracic aortic dissection. J Int Med Res, 2017, 45(5): 1574-1584.
13.	朱水波, 朱健, 郗二平, 等. 不開胸“雜交”手術治療主動脈弓部夾層的近中期隨訪研究. 中國胸心血管外科臨床雜志, 2016, 23(10): 988-991.
14.	Wang M, Dong D, Yuan H, et al. Hybrid versusin vitro fenestration for preserving the left subclavian artery in patients undergoing thoracic endovascular aortic repair with unfavorable proximal landing zone. Vascular, 2020, 28(1): 42-47.
15.	張省, 秦金保, 李維敏, 等. 拓展近端錨定區對Stanford B型主動脈夾層腔內修復術預后的影響. 中華外科雜志, 2018, 56(10): 760-763.
16.	陳凱, 景在平, 張磊, 等. 主動脈夾層腔內隔絕術后再干預的原因及危險因素分析. 中國胸心血管外科臨床雜志, 2016, 23(5): 425-429.
17.	李樹春, 周慶, 潘俊, 等. Stanford B型主動脈夾層腔內修復術后并發A型夾層的外科治療. 中國胸心血管外科臨床雜志, 2019, 26(8): 826-828.
18.	Davidovic L, Sladojevic M, Koncar I, et al. Late complication after thoracic endovascular aortic repair: What is the role of an open surgical conversion? Ann Vasc Surg, 2018, 47: 238-246.
19.	高永山, 郭曦, 吳文輝, 等. 急性Stanford B型主動脈夾層行腔內隔絕術后的主動脈重塑. 中華胸心血管外科雜志, 2017, 33(12): 725-728.
20.	Veger HTC, Pasveer EH, Visser MJT. Where to fenestrate in aortic dissection type B? An ex vivo study. Ann Vasc Surg, 2017, 43: 296-301.

1. Lombardi JV, Hughes GC, Appoo JJ, et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg, 2020, 71(3): 723-747.
2. Mokashi SA, Svensson LG. Guidelines for the management of thoracic aortic disease in 2017. Gen Thorac Cardiovasc Surg, 2019, 67(1): 59-65.
3. Norton EL, Williams DM, Kim KM, et al. Management of acute type B aortic dissection with malperfusion via endovascular fenestration/stenting. J Thorac Cardiovasc Surg, 2020, 160(5): 1151-1161.
4. 韓嘯, 宋來春, 符竣, 等. 雜交手術治療Stanford B型復雜型主動脈夾層的近中期效果. 中國心血管病研究, 2015, 13(8): 744-746.
5. Brescia AA, Patel HJ, Likosky DS, et al. Volume-outcome relationships in surgical and endovascular repair of aortic dissection. Ann Thorac Surg, 2019, 108(5): 1299-1306.
6. 周小彪, 宋曼, 郭宏偉, 等. 胸主動脈腔內修復術治療B型主動脈夾層的早中期結果. 中華血管外科雜志, 2020, 5(3): 175-180.
7. Boufi M, Patterson BO, Loundou AD, et al. Endovascular versus open repair for chronic type B dissection treatment: A meta-analysis. Ann Thorac Surg, 2019, 107(5): 1559-1570.
8. 金少雄, 楊建勝. 原位開窗聯合煙囪技術治療累及左側頸總動脈的主動脈夾層的療效分析. 中國胸心血管外科臨床雜志, 2020, 27(9): 1020-1024.
9. Tadros RO, Tang GHL, Barnes HJ, et al. Optimal treatment of uncomplicated type B aortic dissection: JACC review topic of the week. J Am Coll Cardiol, 2019, 74(11): 1494-1504.
10. 胡凡果, 朱杰昌, 戴向晨, 等. 體外預開窗腔內修復治療非健康錨定區及短錨定區B型主動脈夾層的前瞻性單中心研究. 中華普通外科雜志, 2020, 35(7): 536-539.
11. 高偉, 劉燊, 丘俊濤, 等. 主動脈弓降部病變患者胸主動脈腔內治療同期左鎖骨下動脈血流重建的近中期效果. 中華胸心血管外科雜志, 2017, 33(10): 587-590.
12. Liu Z, Zhang Y, Liu C, et al. Treatment of serious complications following endovascular aortic repair for type B thoracic aortic dissection. J Int Med Res, 2017, 45(5): 1574-1584.
13. 朱水波, 朱健, 郗二平, 等. 不開胸“雜交”手術治療主動脈弓部夾層的近中期隨訪研究. 中國胸心血管外科臨床雜志, 2016, 23(10): 988-991.
14. Wang M, Dong D, Yuan H, et al. Hybrid versusin vitro fenestration for preserving the left subclavian artery in patients undergoing thoracic endovascular aortic repair with unfavorable proximal landing zone. Vascular, 2020, 28(1): 42-47.
15. 張省, 秦金保, 李維敏, 等. 拓展近端錨定區對Stanford B型主動脈夾層腔內修復術預后的影響. 中華外科雜志, 2018, 56(10): 760-763.
16. 陳凱, 景在平, 張磊, 等. 主動脈夾層腔內隔絕術后再干預的原因及危險因素分析. 中國胸心血管外科臨床雜志, 2016, 23(5): 425-429.
17. 李樹春, 周慶, 潘俊, 等. Stanford B型主動脈夾層腔內修復術后并發A型夾層的外科治療. 中國胸心血管外科臨床雜志, 2019, 26(8): 826-828.
18. Davidovic L, Sladojevic M, Koncar I, et al. Late complication after thoracic endovascular aortic repair: What is the role of an open surgical conversion? Ann Vasc Surg, 2018, 47: 238-246.
19. 高永山, 郭曦, 吳文輝, 等. 急性Stanford B型主動脈夾層行腔內隔絕術后的主動脈重塑. 中華胸心血管外科雜志, 2017, 33(12): 725-728.
20. Veger HTC, Pasveer EH, Visser MJT. Where to fenestrate in aortic dissection type B? An ex vivo study. Ann Vasc Surg, 2017, 43: 296-301.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical effect of in vitro fenestration on reconstruction of left subclavian artery in endovascular treatment of aortic dissection

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