Clinical research of complications and treatment of complex Stanford type B aortic dissection of hybrid surgical technique_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

Halimulati·MUERTIZHA , Haerman·AJIHAN ,  Sailike·MAGAOWEIYA , Baoerjiang·ASIHAER , Qiamixi·BIEZIERJIAN

Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R.China;

Corresponding?author：

Sailike·MAGAOWEIYA, Email: sairike@126.com

Keywords：

complex aortic dissection; hybrid surgery; endovascular exclusion; chimney technique

DOI：

10.7507/1007-9424.201608086

Video：

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Objective To discusses the feasibilities of the hybrid surgical treatment of Stanford type B aortic dissection. Methods From August 2011 to August 2015 a total of 14 cases of complex Stanford type B aortic dissection patients had been completed hybrid surgery. Among them 11 cases of men and 3 cases of women, aged 22 to 62, an average of 44±7.2 years old. Twelve cases with dissecting aneurysm involving the aortic arch and its three vascular branch. There were 2 cases of patients after TEVER, occurred new dissection or pseudoaneurysms, and had hybrid surgery by traditional thoracotomy; 3 cases involving carotid artery were received neck-neck hybrid surgery, and 7 cases involving left subclavian artery were received neck-lock hybrid surgery. Two cases of dissecting aneurysm involving the iliac artery to thrombosis that result in lower limb ischemia, then femoral to femoral artery hybrid surgery were performed. Results All the patients were successfully completed the operation of covered stent implantation and hybrid surgery. Intraoperative angiography showed that the position of the stent was accurate, the interlayer isolation was successful, there was no obvious leakage and displacement of the stent, the true lumen blood flow of the aortic dissection was returned to normal, and bypass blood and target blood vessels were unobstructed. Fourteen patients were followed-up for a period of 3 to 36 months, with an average of (24.0±8.2) months. In 1 month after operation, pleural effusion occurred in 1 case, there was 1 case of cerebral stroke in two days after surgery, incision hematoma occurred in 1 case in 10 days after surgery, and the other patients had no postoperative death and severe complications. All 14 patients were followed-up and returned to normal life. Conclusion The hybrid operations can increase the success rate of TEVAR in complex Stanford type B aortic dissection patients, and early and mid-term results are satisfactory.

Citation： Halimulati·MUERTIZHA, Haerman·AJIHAN, Sailike·MAGAOWEIYA, Baoerjiang·ASIHAER, Qiamixi·BIEZIERJIAN. Clinical research of complications and treatment of complex Stanford type B aortic dissection of hybrid surgical technique. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(4): 469-473. doi: 10.7507/1007-9424.201608086 Copy

1.	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.
2.	Kuratani T. Best surgical option for arch extension of type B dissection: the endovascular approach. Ann Cardiothorac Surg, 2014, 3(3): 292-299.
3.	Hogendoorn W, Schl?sser FJ, Moll FL, et al. Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg, 2013, 58(2): 502-511.
4.	Schoder M, Lammer J, Czerny M. Endovascular aortic arch repair: hopes and certainties. Eur J Vasc Endovasc Surg, 2009, 38(3): 255-261.
5.	韓向軍, 徐克. B型主動脈夾層腔內修復治療的薈萃分析. 介入放射學雜志, 2011, 20(7): 530-533.
6.	Gandet T, Canaud L, Ozdemir BA, et al. Factors favoring retrograde aortic dissection after endovascular aortic arch repair. J Thorac Cardiovasc Surg, 2015, 150(1): 136-142.
7.	Matalanis G, Hata M, Buxton BF. A retrospective comparative study of deep hypothermic circulatory arrest, retrograde, and antegrade cerebral perfusion in aortic arch surgery. Ann Thorac Cardiovasc Surg, 2003, 9(3): 174-179.
8.	鮑春榮, 梅舉, 丁芳寶, 等. 27例主動脈弓部病變患者一期雜交技術治療的早中期結果. 中華胸心外科雜志, 2015, 31(5): 293-296.
9.	魏以楨, 常謙, 于存濤, 等. 一期雜交手術治療累及主動脈弓遠端的降主動脈病變. 中國胸心血管外科臨床雜志, 2011, 18(2): 99-103.
10.	丁盛, 張近寶, 張立平, 等. 雜交手術治療累及弓部的主動脈夾層的臨床研究. 生物醫學工程與臨床, 2012, 16(5): 434-437.
11.	Mitchell RS, Ishimaru S, Ehrlich MP, et al. First International Summit on Thoracic Aortic Endografting: roundtable on thoracic aortic dissection as an indication for endografting. J Endovasc Ther, 2002, 9 Suppl 2: Ⅱ98-105.
12.	張勇, 王勝, 梁家立. 雜交手術在治療B型主動脈夾層中的應用. 中國結合臨床, 2013, 29(1): 87-89.
13.	Fujikawa T, Yamamoto S, Sekine Y, et al. Operative results and clinical features of chronic Stanford type B aortic dissection: examination of 234 patients over 6 years. Eur J Vasc Endovasc Surg, 2015, 50(6): 738-743.
14.	Bell D, Bassin L, Neale M, et al. A review of the endovascular management of thoracic aortic pathology. Heart Lung Circ, 2015, 24(12): 1211-1215.
15.	Lu Q, Feng J, Zhou J, et al. Endovascular repair by customized branched stent-graft: a promising treatment for chronic aortic dissection involving the arch branches. J Thorac Cardiovasc Surg, 2015, 150(6): 1631-1638. e5.
16.	張宏鵬, 郭偉, 劉小平, 等. 雜交技術治療主動脈弓部病變的近遠期結果. 中國普外基礎與臨床雜志, 2011, 18(10): 1039-1042.
17.	Zhang T, Jiang W, Lu H, et al. Thoracic endovascular aortic repair combined with assistant techniques and devices for the treatment of acute complicated Stanford type B aortic dissections involving aortic arch. Ann Vasc Surg, 2016, 32: 88-97.
18.	Ramdass M. TEVAR for symptomatic Stanford B dissection: a systematic review of 30-day mortality and morbidity. Thorac Cardiovasc Surg, 2015, 63(2): 97-112.
19.	Wang S, Chang G, Li X, et al. Endovascular treatment of arch and proximal thoracic aortic lesions. J Vasc Surg, 2008, 48(1): 64-68.
20.	Melissano G, Civilini E, Bertoglio L, et al. Results of endografting of the aortic arch in different landing zones. Eur J Vasc Endovasc Surg, 2007, 33(5): 561-566.

1. 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.
2. Kuratani T. Best surgical option for arch extension of type B dissection: the endovascular approach. Ann Cardiothorac Surg, 2014, 3(3): 292-299.
3. Hogendoorn W, Schl?sser FJ, Moll FL, et al. Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg, 2013, 58(2): 502-511.
4. Schoder M, Lammer J, Czerny M. Endovascular aortic arch repair: hopes and certainties. Eur J Vasc Endovasc Surg, 2009, 38(3): 255-261.
5. 韓向軍, 徐克. B型主動脈夾層腔內修復治療的薈萃分析. 介入放射學雜志, 2011, 20(7): 530-533.
6. Gandet T, Canaud L, Ozdemir BA, et al. Factors favoring retrograde aortic dissection after endovascular aortic arch repair. J Thorac Cardiovasc Surg, 2015, 150(1): 136-142.
7. Matalanis G, Hata M, Buxton BF. A retrospective comparative study of deep hypothermic circulatory arrest, retrograde, and antegrade cerebral perfusion in aortic arch surgery. Ann Thorac Cardiovasc Surg, 2003, 9(3): 174-179.
8. 鮑春榮, 梅舉, 丁芳寶, 等. 27例主動脈弓部病變患者一期雜交技術治療的早中期結果. 中華胸心外科雜志, 2015, 31(5): 293-296.
9. 魏以楨, 常謙, 于存濤, 等. 一期雜交手術治療累及主動脈弓遠端的降主動脈病變. 中國胸心血管外科臨床雜志, 2011, 18(2): 99-103.
10. 丁盛, 張近寶, 張立平, 等. 雜交手術治療累及弓部的主動脈夾層的臨床研究. 生物醫學工程與臨床, 2012, 16(5): 434-437.
11. Mitchell RS, Ishimaru S, Ehrlich MP, et al. First International Summit on Thoracic Aortic Endografting: roundtable on thoracic aortic dissection as an indication for endografting. J Endovasc Ther, 2002, 9 Suppl 2: Ⅱ98-105.
12. 張勇, 王勝, 梁家立. 雜交手術在治療B型主動脈夾層中的應用. 中國結合臨床, 2013, 29(1): 87-89.
13. Fujikawa T, Yamamoto S, Sekine Y, et al. Operative results and clinical features of chronic Stanford type B aortic dissection: examination of 234 patients over 6 years. Eur J Vasc Endovasc Surg, 2015, 50(6): 738-743.
14. Bell D, Bassin L, Neale M, et al. A review of the endovascular management of thoracic aortic pathology. Heart Lung Circ, 2015, 24(12): 1211-1215.
15. Lu Q, Feng J, Zhou J, et al. Endovascular repair by customized branched stent-graft: a promising treatment for chronic aortic dissection involving the arch branches. J Thorac Cardiovasc Surg, 2015, 150(6): 1631-1638. e5.
16. 張宏鵬, 郭偉, 劉小平, 等. 雜交技術治療主動脈弓部病變的近遠期結果. 中國普外基礎與臨床雜志, 2011, 18(10): 1039-1042.
17. Zhang T, Jiang W, Lu H, et al. Thoracic endovascular aortic repair combined with assistant techniques and devices for the treatment of acute complicated Stanford type B aortic dissections involving aortic arch. Ann Vasc Surg, 2016, 32: 88-97.
18. Ramdass M. TEVAR for symptomatic Stanford B dissection: a systematic review of 30-day mortality and morbidity. Thorac Cardiovasc Surg, 2015, 63(2): 97-112.
19. Wang S, Chang G, Li X, et al. Endovascular treatment of arch and proximal thoracic aortic lesions. J Vasc Surg, 2008, 48(1): 64-68.
20. Melissano G, Civilini E, Bertoglio L, et al. Results of endografting of the aortic arch in different landing zones. Eur J Vasc Endovasc Surg, 2007, 33(5): 561-566.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical research of complications and treatment of complex Stanford type B aortic dissection of hybrid surgical technique

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